Ono Masamichi, Boethig Dietmar, Goerler Heidi, Lange Melanie, Westhoff-Bleck Mechthild, Breymann Thomas
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
J Thorac Cardiovasc Surg. 2007 Nov;134(5):1199-206. doi: 10.1016/j.jtcvs.2007.08.002.
As mortality and morbidity after the Fontan operation has improved, long-term outcome, including developmental aspects, have become more important. To understand the long-term effects of this operation, we followed somatic development for up to 15 years.
We evaluated 90 patients who underwent the Fontan operation between 1984 and 2004 (mean follow-up, 11.8 +/- 4.2 years). The modified Fontan operations were atriopulmonary anastomosis (n = 19) and total cavopulmonary connection (n = 71). Mean age at the time of surgical intervention was 5.5 +/- 4.8 years. Weight, height, and body mass index were evaluated preoperatively and postoperatively and given as percentiles on a normal growth curve.
Postoperative weight, height, and body mass index reached the 47.2 +/- 35.6, 37.9 +/- 30.4, and 41.6 +/- 31.2 percentiles, which were significantly better than preoperative values (the 21.6 +/- 25.9, 25.9 +/- 25.7, and 20.0 +/- 25.1 percentiles). Although neither early surgical intervention nor anatomic features affected postoperative growth, early Fontan completion demonstrated better somatic development in subgroups of tricuspid atresia. Prior bidirectional Glenn shunting provided better weight gain before the Fontan operation. Prior atrioseptectomy, central shunt, and pulmonary artery reconstruction were associated with impaired somatic development. Reoperation and catheter-based intervention improved somatic development.
Long-term catch-up growth can be observed in patients after the Fontan operation. Early volume-unloading procedures might lead to better somatic growth. Prior atrioseptectomy, central shunt, and pulmonary artery reconstruction are associated with impaired weight and height gain, implying that the severity of the underlying diseases affects postoperative somatic development.
随着Fontan手术死亡率和发病率的改善，包括发育方面的长期预后变得更加重要。为了解该手术的长期影响，我们对患者的躯体发育进行了长达15年的随访。
我们评估了1984年至2004年间接受Fontan手术的90例患者（平均随访时间为11.8±4.2年）。改良Fontan手术包括心房肺吻合术（n = 19）和全腔静脉肺动脉连接术（n = 71）。手术干预时的平均年龄为5.5±4.8岁。术前和术后评估体重、身高和体重指数，并以正常生长曲线的百分位数表示。
术后体重、身高和体重指数分别达到第47.2±35.6、37.9±30.4和41.6±31.2百分位数，显著优于术前值（第21.6±25.9、25.9±25.7和20.0±25.1百分位数）。尽管早期手术干预和解剖特征均未影响术后生长，但早期完成Fontan手术在三尖瓣闭锁亚组中显示出更好的躯体发育。先前的双向Glenn分流术在Fontan手术前提供了更好体重增加。先前的房间隔切除术、中心分流术和肺动脉重建与躯体发育受损有关。再次手术和基于导管的介入改善了躯体发育。
Fontan手术后患者可观察到长期的追赶性生长。早期容量卸载手术可能导致更好的躯体生长。先前的房间隔切除术、中心分流术和肺动脉重建与体重和身高增加受损有关，这意味着潜在疾病的严重程度会影响术后躯体发育。
