Fontan手术后出现的体静脉至肺静脉侧支循环的特征与治疗

Characterization and treatment of systemic venous to pulmonary venous collaterals seen after the Fontan operation.

作者信息

Sugiyama Hisashi, Yoo Shi-Joon, Williams William, Benson Lee N

机构信息

Department of Pediatrics and Diagnostic Imaging, The Hospital for Sick Children, The University of Toronto, School of Medicine, Toronto, Ontario, Canada.

出版信息

Cardiol Young. 2003 Oct;13(5):424-30.

PMID:14694936

Abstract

OBJECTIVES

To determine the anatomical characteristics of systemic venous collaterals formed after the Fontan operation, and the efficacy of a transcatheter strategy for management.

METHODS

We reviewed retrospectively the data from cardiac catherization of 50 persistently cyanotic patients after the Fontan operation.

RESULTS

A total of 54 transcatheter interventions were performed, at a mean age of 6.3 +/- 3.5 years, a mean interval of 2.7 +/- 2.9 years from completion of the Fontan circulation. Of 38 patients who had fenestration of the baffle at the time of surgery, 25 had patency of the fenestration, and 24 had the fenestration occluded with a device at the time of interventional treatment for associated venous collaterals. We identified a total of 68 systemic venous collateral channels, of which 36 (53%) were supracardiac, 12 (18%) cardiac, and 20 (29%) infracardiac in origin. The most common site of origin was the brachiocephalic vein (44%), followed by the left phrenic vein (25%). A longer time from surgery, at 3.3 +/- 3.4 years, was associated with the identification of collaterals having a diameter larger than 4 mm (p < 0.01). The mean pulmonary arterial pressure was higher in those with larger compared to those with smaller collaterals (13.3 +/- 2.8 versus 11.1 +/- 2.0 mmHg, p < 0.01). Coils were used for occlusion of 61 vessels, and a Rashkind occluder for the remaining 7. After exclusion of the patients undergoing simultaneous closure of their fenestration, systemic saturation of oxygen increased from 89 +/- 6% to 95 +/- 3% (p < 0.01).

CONCLUSION

Venous collateral channels are common in patients suffering progressive cyanosis in the setting of the Fontan circulation. The collaterals increase in size with time, and are associated with higher pulmonary arterial pressures. Transcatheter treatment is feasible, and results in resolution of cyanosis. Only continuing follow-up will show whether further collateralization occurs in time.

摘要

目的

确定Fontan手术后继发的体静脉侧支循环的解剖特征，以及经导管治疗策略的疗效。

方法

我们回顾性分析了50例Fontan手术后持续发绀患者的心脏导管检查数据。

结果

共进行了54次经导管干预，平均年龄为6.3±3.5岁，距Fontan循环完成的平均间隔时间为2.7±2.9年。在手术时进行了房间隔开窗的38例患者中，25例开窗通畅，24例在针对相关体静脉侧支循环的介入治疗时用装置封堵了开窗。我们共识别出68条体静脉侧支通道，其中36条（53%）起源于心上，12条（18%）起源于心内，20条（29%）起源于心下。最常见的起源部位是头臂静脉（44%），其次是左膈静脉（25%）。手术时间较长，为3.3±3.4年，与识别出直径大于4mm的侧支循环相关（p<0.01）。侧支循环较大者的平均肺动脉压高于较小者（13.3±2.8对11.1±2.0mmHg，p<0.01）。61条血管用弹簧圈封堵，其余7条用Rashkind封堵器封堵。排除同时进行开窗封堵的患者后，体循环氧饱和度从89±6%升至95±3%（p<0.01）。