Calvaruso Davide F, Rubino Antonio, Ocello Salvatore, Salviato Nicoletta, Guardì Diego, Petruccelli David F, Cipriani Adriano, Fattouch Khalil, Agati Salvatore, Mignosa Carmelo, Zannini Lucio, Marcelletti Carlo F
Department of Pediatric Cardiac Surgery Marta e Milagros, Azienda di Rilievo Nazionale e di Alta Specializzazione, Ospedale Civico, Palermo, Italy.
Ann Thorac Surg. 2008 Apr;85(4):1389-95; discussion 1395-6. doi: 10.1016/j.athoracsur.2008.01.013.
We sought to investigate the role of the bidirectional Glenn with antegrade pulmonary blood flow in the surgical history of children with univentricular hearts.
A series of 246 patients, from three joint institutions, having univentricular heart with restricted but not critical pulmonary blood flow received a bidirectional cavopulmonary shunt with additional forward pulmonary blood flow. All patients have been studied according to their progression, or not, to Fontan operation. Two hundred and eight (84.5%) patients underwent bidirectional cavopulmonary anastomosis as primary palliation. Twenty patients (8.1%) with previous pulmonary artery banding were also enrolled in the study. Patients who had received additional pulmonary blood flow through a previous systemic to pulmonary artery shunt for the critical pulmonary blood flow were excluded.
No in-hospital death occurred. Follow-up was complete at 100%. Mean follow-up was 4.2 +/- 2.8 years (range, 6 months to 7 years). During the observational period 73 (29.7%) patients, considered optimal candidates, underwent Fontan completion for increasing cyanosis and (or) hematocrit and (or) fatigue with exertion. Three patients expired after total cavopulmonary connection (3 of 73; 4.1% mortality rate). The remaining 173 (70.3%) patients are alive with initial palliation. All patients were still well palliated with an arterial oxygen saturation at rest about 90%.
According to our experience and results, bidirectional Glenn with antegrade pulmonary blood flow may be an excellent temporary palliation prior to a Fontan operation, which can be performed at the onset of symptoms. Bidirectional Glenn may also be the best possible palliation for a suboptimal candidate for Fontan.
我们试图研究带顺行性肺血流的双向格林手术在单心室患儿手术治疗史中的作用。
来自三个联合机构的246例单心室患儿，肺血流受限但不严重，接受了带额外顺行性肺血流的双向腔肺分流术。所有患者均根据其是否进展至Fontan手术进行了研究。208例（84.5%）患者接受双向腔肺吻合术作为初始姑息治疗。20例（8.1%）既往接受过肺动脉环扎术的患者也纳入了研究。排除既往因严重肺血流不足而通过体肺分流术接受额外肺血流的患者。
无住院死亡发生。随访完成率为100%。平均随访时间为4.2±2.8年（范围6个月至7年）。在观察期内，73例（29.7%）被认为是最佳候选者的患者，因紫绀加重、和（或）血细胞比容升高、和（或）劳力性疲劳而接受了Fontan手术。3例患者在全腔肺连接术后死亡（73例中的3例；死亡率4.1%）。其余173例（70.3%）患者接受初始姑息治疗后存活。所有患者静息时动脉血氧饱和度仍维持在约90%，姑息治疗效果良好。
根据我们的经验和结果，带顺行性肺血流的双向格林手术可能是Fontan手术前一种出色的临时姑息治疗方法，可在症状出现时进行。对于Fontan手术的次优候选者，双向格林手术也可能是最佳的姑息治疗方法。
