Desai Tarak, Wright John, Dhillon Rami, Stumper Oliver
The Heart Unit, Birmingham Children's Hospital-NHS Trust, Birmingham, UK.
Heart. 2007 Apr;93(4):510-3. doi: 10.1136/hrt.2006.093757. Epub 2006 Dec 12.
Ventricle-pulmonary artery connections in patients after the Fontan procedure lead to ineffective volume loading and can cause long term problems. In patients with a cavopulmonary shunt anterograde pulmonary blood flow is frequently maintained, but can cause significant volume loading of the heart or complicate the subsequent Fontan procedure.
To evaluate the use of transcatheter closure of a ventricle-pulmonary artery communication in the setting of a cavopulmonary shunt or after the Fontan procedure.
Retrospective study at a tertiary referral centre. Eight patients (age 1.5-18 years, mean 7.8 years).
cardiac failure or persistent pleural effusions after cavopulmonary shunt (n = 2) or after Fontan (n = 3) and abolishing the volume load of the single ventricle prior to Fontan completion (n = 3).
Devices used: Rashkind Umbrella (n = 1), Amplatzer PDA (n = 7) and Amplatzer ASD (n = 1). One patient required two devices. There were no procedural complications. All 3 patients with prolonged pleural effusions (1 post CP shunt and 2 post Fontan) showed complete resolution between 4 and 10 days after catheter closure. Two patients underwent transcatheter occlusion for progressive ventricular dilatation and cardiac failure. The first patient was post Fontan and showed gradual improvement in ventricular function. The second patient (post CP shunt) was in end stage cardiac failure due to severe AV valve regurgitation. The patient died 48 hours after an uncomplicated procedure due to ventricular failure and electromechanical dissociation (non-procedure-related cardiac death). Three patients underwent catheter closure to off-load the systemic ventricle prior to the Fontan procedure. The device had to be removed prior to release in one patient, due to unsatisfactory position.
Transcatheter closure of ventricle-pulmonary artery communication is a safe and effective technique in the treatment of selected patients after cavopulmonary shunt or Fontan procedure with early or late complications due to inappropriate pulmonary blood flow. This intervention should also be considered in the preparation for the Fontan procedure in selected patients with ventricular overload.
Fontan手术患者的心室 - 肺动脉连接导致容量负荷无效，并可能引起长期问题。在施行腔肺分流术的患者中，顺行性肺血流通常得以维持，但可导致心脏显著的容量负荷或使随后的Fontan手术复杂化。
评估在腔肺分流或Fontan手术后经导管闭合心室 - 肺动脉交通的应用。
在一家三级转诊中心进行回顾性研究。8例患者（年龄1.5 - 18岁，平均7.8岁）。
腔肺分流术后（n = 2）或Fontan术后（n = 3）出现心力衰竭或持续性胸腔积液，以及在完成Fontan手术前消除单心室的容量负荷（n = 3）。
使用的装置：Rashkind伞（n = 1）、Amplatzer动脉导管未闭封堵器（n = 7）和Amplatzer房间隔缺损封堵器（n = 1）。1例患者需要使用两个装置。无手术并发症。所有3例有长期胸腔积液的患者（1例腔肺分流术后，2例Fontan术后）在导管闭合后4至10天胸腔积液完全消退。2例患者因进行性心室扩张和心力衰竭接受经导管封堵。首例患者为Fontan术后，心室功能逐渐改善。第二例患者（腔肺分流术后）因严重房室瓣反流处于终末期心力衰竭。该患者在一次无并发症的手术后48小时因心室衰竭和电机械分离（与手术无关的心脏死亡）死亡。3例患者在Fontan手术前接受导管闭合以减轻体循环心室的负荷。1例患者因位置不满意，在释放前不得不取出装置。
经导管闭合心室 - 肺动脉交通是一种安全有效的技术，可用于治疗腔肺分流或Fontan手术后因肺血流不当出现早期或晚期并发症的特定患者。对于选定的有心室超负荷的患者，在准备Fontan手术时也应考虑这种干预措施。
