Erek Ersin, Yalçinbaş Yusuf Kenan, Türkekul Yasemin, Oztarhan Kazim, Colakoğlu Ayşe, Saygili Arda, Sarioğlu Ayşe, Sarioğlu Tayyar
Acibadem Bakirköy Hastanesi, Kardiyovasküler Cerrahi Bölümü, Istanbul, Türkiye.
Anadolu Kardiyol Derg. 2009 Jun;9(3):215-22.
In this study, we report the current indications, early-midterm results and the outcome of pulmonary artery banding (PAB) operation after definitive repair.
Between 2000 and 2007, 28 infants underwent PAB operation. Ages were between 21 days and 6 months (mean 3.0+/-1.7 months). All patients had pulmonary hypertension at systemic level. Fourteen patients were candidates for terminal biventricular repair [atrioventricular septal defect (AVSD) (n=6), double outlet right ventricle (DORV) +ventricular septal defect (VSD) (n=4), Swiss cheese VSD (n=2), transposition of the great arteries (TGA) +Swiss cheese VSD (n=1), ASD+VSD+aortic coarctation (n=1)], and the remaining 14 were candidates for terminal univentricular repair [double inlet left ventricle (n=5), double inlet right ventricle (n=2), AVSD+left ventricular (LV) hypoplasia (n=2), DORV+LV hypoplasia (n=2); tricuspid atresia (n=1), left AV valve atresia (n=1), TGA+Swiss cheese VSD+LV hypoplasia (n=1).
Three patients (1 in biventricular group; 2 in univentricular group) died in the early postoperative period (10.7%). Three patients needed long duration of mechanical ventilatory support. Twenty- three of the surviving patients (92%) were followed -up between 1 month to 7 years. Currently 7 patients underwent successful biventricular repair and five patients underwent univentricular repair (extracardiac Fontan 3; Glenn 2). Two patients died early and 1 patient died 1 year after extracardiac Fontan operation. Survival for biventricular group was 92.8% at 1 and 4 years and 85.7% and 58.4% respectively for univentricular group (p<0.05).
Pulmonary artery banding operation has still a significant role in the palliation of certain congenital cardiac anomalies. Outcome of patients who are candidates for biventricular repair is better than the univentricular repairs.
在本研究中，我们报告了最终修复术后肺动脉环缩术（PAB）的当前适应证、早中期结果及预后。
2000年至2007年间，28例婴儿接受了PAB手术。年龄在21天至6个月之间（平均3.0±1.7个月）。所有患者均存在体循环水平的肺动脉高压。14例患者为双心室最终修复的候选者[房室间隔缺损（AVSD）（n = 6）、右心室双出口（DORV）+室间隔缺损（VSD）（n = 4）、瑞士奶酪样VSD（n = 2）、大动脉转位（TGA）+瑞士奶酪样VSD（n = 1）、房间隔缺损（ASD）+VSD+主动脉缩窄（n = 1）]，其余14例为单心室最终修复的候选者[双入口左心室（n = 5）、双入口右心室（n = 2）、AVSD+左心室（LV）发育不全（n = 2）、DORV+LV发育不全（n = 2）；三尖瓣闭锁（n = 1）、左房室瓣闭锁（n = 1）、TGA+瑞士奶酪样VSD+LV发育不全（n = 1）]。
3例患者（双心室组1例；单心室组2例）在术后早期死亡（10.7%）。3例患者需要长时间的机械通气支持。23例存活患者（92%）在1个月至7年之间接受了随访。目前，7例患者成功进行了双心室修复，5例患者进行了单心室修复（心外Fontan手术者3例；Glenn手术者2例）。2例患者早期死亡，1例患者在心外Fontan手术后1年死亡。双心室组1年和4年的生存率分别为92.8%，单心室组分别为85.7%和58.4%（p<0.05）。
肺动脉环缩术在某些先天性心脏畸形的姑息治疗中仍具有重要作用。双心室修复候选者的预后优于单心室修复者。
