Swain Sunil K, Dharmapuram Anil K, Reddy Pramod, Ramdoss Nagarajan, Raghavan Sreekanth S, Kona Samba M
Department of Pediatric Cardiac Surgery, Apollo Children's Heart Hospital, Hyderabad, India.
Asian Cardiovasc Thorac Ann. 2008 Jan;16(1):7-10. doi: 10.1177/021849230801600103.
A systemic-pulmonary artery shunt in neonates with decreased pulmonary blood flow is technically demanding. We describe our surgical technique, postoperative management, and results in 19 neonates who underwent a modified Blalock-Taussig shunt between April 2003 and March 2006. Prostaglandin infusion was required in 8 patients who were critically cyanosed, and 5 were on inotropic support preoperatively. A 3.5 or 4.0-mm polytetrafluoroethylene graft was anastomosed with 8/0 polypropylene suture. Postoperatively, systemic pressure was kept slightly higher than normal, and heparin was started early. One patient required revision of the shunt, and one was reexplored for bleeding. There were 2 hospital deaths (mortality, 11%) in patients with preoperative hemodynamic instability. The mean follow-up period was 12 months, with no late postoperative shunt blockage or death. Meticulous surgical technique and judicious use of heparin and inotropic agents improved the outcome and reduced the incidence of shunt blockage and reexploration for bleeding.
对肺血流量减少的新生儿进行体肺分流术在技术上要求很高。我们描述了2003年4月至2006年3月期间接受改良布莱洛克-陶西格分流术的19例新生儿的手术技术、术后管理及结果。8例严重发绀的患儿需要输注前列腺素，5例术前接受了正性肌力支持。用8-0聚丙烯缝线将3.5或4.0毫米的聚四氟乙烯移植物进行吻合。术后，将体循环压力维持在略高于正常的水平，并早期开始使用肝素。1例患者需要对分流术进行修正，1例因出血再次进行探查。术前血流动力学不稳定的患者中有2例住院死亡（死亡率为11%）。平均随访期为12个月，术后无晚期分流阻塞或死亡情况。精心的手术技术以及合理使用肝素和正性肌力药物改善了治疗效果，降低了分流阻塞和因出血再次探查的发生率。
