Masura Jozef, Bordacova Lucia, Tittel Peter, Berden Pavel, Podnar Tomaz
Children's Cardiac Center, University Children's Hospital, Bratislava, Slovakia.
Catheter Cardiovasc Interv. 2008 May 1;71(6):843-9. doi: 10.1002/ccd.21540.
To determine causes of cyanosis and to evaluate percutaneous management of cyanosis in a group of consecutive Fontan patients.
A variety of communications allow a right-to-left shunt in Fontan circulation causing cyanosis and these communications are amenable to percutaneous closure.
Between November 1997 and November 2007, 45 consecutive patients ranging in age from 2.5 to 26 years (median 8 years) with Fontan circulation and cyanosis underwent cardiac catheterization and percutaneous closure of superfluous communications using different types of Amplatzer occluders.
Altogether, 51 communications were detected and 50 of them were closed. In 5 patients (11.1%), multiple communications were present and were closed. Fenestration was detected in 37 of 41 patients (90.2%) after total cavopulmonary connection and all were closed by Amplatzer septal occluders. Five venous collaterals were revealed in 3 of 41 patients (7.3%) with total cavopulmonary anastomosis and were closed by Amplatzer vascular plugs. In 3 patients, lateral tunnel leaks were detected and were closed by Amplatzer PFO occluders. In 4 patients after Kawashima operation, 3 major pulmonary arterio-venous malformations and single venous collateral contributed to the cyanosis and all were closed using Amplatzer vascular plugs.
Different communications cause cyanosis in Fontan patients. Progressive decline of percutaneous oxygen saturation is suggestive of development of venous collaterals or pulmonary arteriovenous malformations. Superfluous communications are amenable to percutaneous closure using various types of Amplatzer occluders. A novel use of an Amplatzer PFO occluder for the percutaneous closure of a lateral tunnel leak is described.
确定一组连续的Fontan手术患者发绀的原因，并评估经皮治疗发绀的效果。
多种交通支可导致Fontan循环出现右向左分流，从而引起发绀，且这些交通支适合经皮封堵。
1997年11月至2007年11月，45例年龄在2.5至26岁（中位数8岁）、患有Fontan循环并发绀的连续患者接受了心导管检查，并使用不同类型的Amplatzer封堵器经皮封堵多余的交通支。
共检测到51个交通支，其中50个被封堵。5例患者（11.1%）存在多个交通支并均被封堵。在41例患者中的37例（90.2%）全腔静脉肺动脉连接术后检测到卵圆孔未闭，均用Amplatzer房间隔封堵器封堵。41例全腔静脉肺动脉吻合术患者中的3例（7.3%）发现5条静脉侧支，并使用Amplatzer血管塞封堵。3例患者检测到侧隧道漏，并使用Amplatzer卵圆孔未闭封堵器封堵。在4例川岛手术后的患者中，3处主要肺动静脉畸形和1条静脉侧支导致发绀，均使用Amplatzer血管塞封堵。
不同的交通支导致Fontan患者发绀。经皮血氧饱和度的逐渐下降提示静脉侧支或肺动静脉畸形的发展。多余的交通支适合使用各种类型的Amplatzer封堵器进行经皮封堵。描述了Amplatzer卵圆孔未闭封堵器在经皮封堵侧隧道漏中的新应用。
