Schreiber Christian, Cleuziou Julie, Cornelsen Juliane K, Hörer Jürgen, Eicken Andreas, Lange Rüdiger
Department of Cardiovascular Surgery, German Heart Center Munich at the Technical University Munich, Germany.
Eur J Cardiothorac Surg. 2008 Sep;34(3):550-4 ;discussion 554-5. doi: 10.1016/j.ejcts.2008.04.043. Epub 2008 Jun 4.
Our institutional policy differs from others substantially, as we never leave any additional blood flow at the time of performing bidirectional cavopulmonary connection (BCPC). The aim was to evaluate the influence of this strategy on hemodynamics and pulmonary artery development.
Between 2001 and 2006 a total of 124 patients had completion to a total cavopulmonary connection (TCPC). Review of 84 angiograms before BCPC and TCPC allowed for analysis of hemodynamic findings and measurement of the pulmonary arteries (PA).
Mean age at BCPC was 12.6+/-15.3 months. Mean age at time of TCPC was 31.3+/-18.7 months, with an interval of 18.6+/-11.8 months between BCPC and completion to extracardiac TCPC. There was no postoperative mortality after BCPC, one patient died after TCPC (1.2%). The mean oxygen saturation increased after BCPC from 74.4% to 79.6% (p<0.01). The mean PA pressures decreased after BCPC from 15.1 to 13.5mmHg (n.s.). The mean left atrial pressure decreased from 5.8 to 4.9mmHg prior to TCPC (p=0.06). The pulmonary/systemic blood flow ratio was 1.4 prior to BCPC and decreased to 0.67 prior to TCPC (p=0.04). The pulmonary/systemic resistance ratio decreased also from 0.19 to 0.07 prior to TCPC (p<0.01). The right PA, as well as the right lower lobe PA, showed a significant increase in diameter after BCPC (p<0.01). The left PA also increased in size, although this was not statistically significant.
After BCPC without additional blood flow, hemodynamic findings are favorable for completion of TCPC. Our findings support our institutional policy not only for an early staging to a BCPC, but likewise a swift completion towards a TCPC.
我们机构的政策与其他机构有很大不同，因为在进行双向腔肺连接（BCPC）时我们从不留下任何额外的血流。目的是评估该策略对血流动力学和肺动脉发育的影响。
2001年至2006年间，共有124例患者完成了全腔肺连接（TCPC）。回顾BCPC和TCPC之前的84份血管造影，以便分析血流动力学结果并测量肺动脉（PA）。
BCPC时的平均年龄为12.6±15.3个月。TCPC时的平均年龄为31.3±18.7个月，BCPC与完成心外TCPC之间的间隔为18.6±11.8个月。BCPC后无术后死亡，1例患者在TCPC后死亡（1.2%）。BCPC后平均氧饱和度从74.4%升至79.6%（p<0.01）。BCPC后平均PA压力从15.1降至13.5mmHg（无统计学意义）。TCPC前平均左心房压力从5.8降至4.9mmHg（p=0.06）。BCPC前肺/体循环血流比为1.4，TCPC前降至0.67（p=0.04）。肺/体循环阻力比在TCPC前也从0.19降至0.07（p<0.01）。BCPC后右肺动脉以及右下叶肺动脉直径显著增加（p<0.01）。左肺动脉大小也增加，尽管无统计学意义。
在无额外血流的BCPC后，血流动力学结果有利于完成TCPC。我们的发现不仅支持我们机构早期进行BCPC分期的政策，同样也支持迅速完成向TCPC的转变。
