Miyaji Kagami, Murakami Arata, Takasaki Tai-ichi, Ohara Kuniyoshi, Takamoto Shinichi, Yoshimura Hirokuni
Department of Thoracic and Cardiovascular Surgery, Kitasato University School of Medicine Kitasato, Sagamihara, Japan.
J Thorac Cardiovasc Surg. 2005 Oct;130(4):1050-3. doi: 10.1016/j.jtcvs.2005.04.026.
There is a risk of myocardial ischemia in patients with pulmonary atresia and intact ventricular septum associated with the right ventricle-dependent coronary circulation. In this patient group, the oxygen delivery to the myocardium depends on the oxygen saturation of the right ventricular cavity. We hypothesized that bidirectional Glenn shunt would improve the oxygenation of right ventricle-dependent coronary circulation relative to a systemic-pulmonary artery shunt. The reduction of systemic venous return to the right atrium due to a bidirectional Glenn shunt could increase the oxygen saturation of the right ventricle in the clinical setting, when the mixture of systemic and pulmonary venous blood is unchanged at the atrial level.
Patients with right ventricle-dependent coronary circulation were defined as those with right ventricle-coronary artery fistulas plus stenoses of the right or left coronary arteries. For 7 patients with right ventricle-dependent coronary circulation before and after bidirectional Glenn shunt, cardiac catheterization was performed and the oxygen saturation of the right ventricular cavity was measured.
For all 7 patients, the bidirectional Glenn shunt was performed at a mean age of 18 months. Ischemic changes in the electrocardiogram before the bidirectional Glenn shunt improved after the procedure in 2 patients. The oxygen saturation of the right ventricular cavity before the bidirectional Glenn shunt was 54.6 +/- 8.8%, and that after the BGS significantly increased to 75.6% +/- 5.8% (P < .01). All 7 patients have subsequently undergone the Fontan procedure with excellent results.
Early bidirectional Glenn shunt could prevent progression of myocardial ischemia in pulmonary atresia with intact ventricular septum with right ventricle-dependent coronary circulation.
在伴有右心室依赖性冠状动脉循环的肺动脉闭锁且室间隔完整的患者中存在心肌缺血风险。在该患者群体中，心肌的氧输送取决于右心室腔的氧饱和度。我们假设相对于体肺分流术，双向格林分流术能改善右心室依赖性冠状动脉循环的氧合。当体循环和肺循环静脉血在心房水平的混合不变时，双向格林分流术导致回流入右心房的体循环静脉血减少，这在临床环境中可能会提高右心室的氧饱和度。
右心室依赖性冠状动脉循环的患者定义为患有右心室 - 冠状动脉瘘以及右冠状动脉或左冠状动脉狭窄的患者。对7例接受双向格林分流术前后的右心室依赖性冠状动脉循环患者进行了心导管检查，并测量了右心室腔的氧饱和度。
所有7例患者进行双向格林分流术的平均年龄为18个月。2例患者在双向格林分流术前心电图的缺血性改变在术后得到改善。双向格林分流术前右心室腔的氧饱和度为54.6±8.8%，术后显著升至75.6%±5.8%（P <.01）。所有7例患者随后均接受了Fontan手术，效果良好。
早期双向格林分流术可预防伴有右心室依赖性冠状动脉循环的肺动脉闭锁且室间隔完整患者的心肌缺血进展。
