Fukae Koji, Kado H
Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Fukuoka, Japan.
Kyobu Geka. 2009 Sep;62(10):853-8; discussion 858-62.
We reviewed the preoperative hemodynamic factors, surgical results and intermediate outcome of Fontan procedure in hypoplastic left heart syndrome (HLHS).
From 1990 to 2006, 34 patients with HLHS completed Fontan procedure in our hospital. We compared preoperative hemodynamic factors, surgical results and postoperative course between HLHS group and functional single right ventricle (SRV) group who had undergone Fontan procedure. In addition, influence of the initial palliation [Norwood procedure with modified Blalock-Taussig (BT) shunt, Norwood procedure with right ventricle (RV)-pulmonary artery (PA) conduit and bilateral PA banding] to surgical results and postoperative course was investigated.
The PA index was smaller in HLHS group than SRV group but there was no difference in surgical results and intermediate outcome between the 2 groups. Although age at Fontan was older in Norwood with BT shunt, preoperative hemodynamic factors, surgical results and intermediate outcome were similar between the 3 groups.
Although the PA index in HLHS group was small, the surgical results of Fontan procedure in HLHS group were comparable with those in SRV group. The surgical result of Fontan procedure was satisfactory irrespective of the initial palliative procedure.
我们回顾了左心发育不全综合征（HLHS）患者Fontan手术的术前血流动力学因素、手术结果及中期预后。
1990年至2006年，我院34例HLHS患者完成了Fontan手术。我们比较了HLHS组与接受Fontan手术的功能性单右心室（SRV）组之间的术前血流动力学因素、手术结果及术后病程。此外，还研究了初始姑息治疗[改良Blalock-Taussig（BT）分流的Norwood手术、右心室（RV）-肺动脉（PA）导管的Norwood手术及双侧PA束带术]对手术结果及术后病程的影响。
HLHS组的肺动脉指数小于SRV组，但两组的手术结果及中期预后无差异。虽然采用BT分流的Norwood手术患者进行Fontan手术时年龄较大，但三组的术前血流动力学因素、手术结果及中期预后相似。
虽然HLHS组的肺动脉指数较小，但HLHS组Fontan手术的结果与SRV组相当。无论初始姑息治疗方法如何，Fontan手术的结果均令人满意。
