Takabayashi Shin, Kado Hideaki, Shiokawa Yuichi, Fukae Kouji, Nakano Toshihide
Department of Cardiovascular Surgery, Fukuoka Children's Hospital, 2-5-1 Tojin-machi, Chuo-ku, Fukuoka 810-0063, Japan.
Eur J Cardiothorac Surg. 2005 Jun;27(6):968-74. doi: 10.1016/j.ejcts.2005.03.005. Epub 2005 Apr 9.
Despite that surgical outcomes of patients with hypoplastic left heart syndrome have improved, one of the problems remaining is the high interstage mortality after a stage I Norwood procedure. The purpose of this study was to determine the hemodynamic characteristics of hypoplastic left heart syndrome after a Norwood procedure. We examined the perioperative hemodynamic differences of the staged operation between the first stage of the Norwood procedure and systemic pulmonary shunt for single right ventricle patients.
Data from 39 patients who underwent a Norwood procedure (right ventricle to pulmonary artery conduit: 19, Blalock-Taussig shunt, 20) were analyzed. There were nine early and seven interstage deaths. Bidirectional cavopulmonary shunt was performed in 15 patients and the Fontan procedure in 9 (group H). We defined the control group as 26 patients who underwent the first stage of a systemic pulmonary shunt for a single ventricle. Bidirectional cavopulmonary shunt was performed in 14 patients and the Fontan procedure in 8 (group C). We compared the perioperative hemodynamics of the staged operation between the two groups.
Cardiothoracic ratio and single ventricular diastolic dimension before bidirectional cavopulmonary shunt were acutely increased in group H (P=0.02, <0.001). There was no significant difference between the two different types of Norwood procedures. The pulmonary artery index for the right heart bypass operation was lower in group H than in group C (P<0.001). Oxygen saturation before bidirectional cavopulmonary shunt in group H decreased (P<0.001) and thus was lower than that in group C (P=0.003). Mortality and the postoperative clinical parameters of the right heart bypass operation were not different between the two groups.
Patients with hypoplastic left heart syndrome showed hemodynamic instability of acutely increased cardiothoracic ratio, and single ventricular diastolic dimension despite decreased oxygen saturation interstage after stage I of a Norwood procedure. This suggests that this hemodynamic characteristics in hypoplastic left heart syndrome correlates with the higher mortality before second stage palliation than in found with single right ventricle patients.
尽管左心发育不全综合征患者的手术效果有所改善，但仍存在的问题之一是一期诺伍德手术后的阶段间死亡率较高。本研究的目的是确定诺伍德手术后左心发育不全综合征的血流动力学特征。我们研究了诺伍德手术第一阶段与单右心室患者的体肺分流术之间分期手术的围手术期血流动力学差异。
分析了39例行诺伍德手术患者的数据（右心室至肺动脉管道：19例，布莱洛克 - 陶西格分流术：20例）。有9例早期死亡和7例阶段间死亡。15例患者进行了双向腔肺分流术，9例进行了Fontan手术（H组）。我们将对照组定义为26例因单心室而行体肺分流术第一阶段的患者。14例患者进行了双向腔肺分流术，8例进行了Fontan手术（C组）。我们比较了两组之间分期手术的围手术期血流动力学。
双向腔肺分流术前，H组的心胸比率和单心室舒张径急性增加（P = 0.02，<0.001）。两种不同类型的诺伍德手术之间无显著差异。H组右心旁路手术的肺动脉指数低于C组（P<0.001）。H组双向腔肺分流术前的氧饱和度降低（P<0.001），因此低于C组（P = 0.003）。两组右心旁路手术的死亡率和术后临床参数无差异。
左心发育不全综合征患者在诺伍德手术第一阶段后，尽管阶段间氧饱和度降低，但仍表现出心胸比率和单心室舒张径急性增加的血流动力学不稳定。这表明左心发育不全综合征的这种血流动力学特征与二期姑息治疗前较高的死亡率相关，高于单右心室患者。
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