Ganigara Madhusudan, Prabhu Atul, Varghese Roy, Pavithran Sreeja, Valliatu John, Nair Raghavan Suresh Kumar
The Madras Medical Mission, Dr J Jayalalitha Nagar, Mogappair, Chennai, Tamil Nadu, India.
Asian Cardiovasc Thorac Ann. 2010 Jun;18(3):253-9. doi: 10.1177/0218492310367961.
The outcomes of 33 consecutive extracardiac Fontan operations performed between 1999 and 2008 in patients who mostly had initial Glenn shunts beyond infancy were reviewed. Preoperatively, the median oxygen saturation was 76.2% and mean pulmonary artery pressure was 10.5 mm Hg. The median age was 4.1 years at Glenn shunt procedure and 10 years at Fontan operation. The duration of chest tube drainage was longer in these patients than in series where Glenn shunts were created at a younger age. All patients received warfarin for 1 year, then warfarin and/or aspirin. At follow-up (median, 14 months), there was no significant ventricular dysfunction. Median oxygen saturation at the last follow-up was 92%. All patients in sinus rhythm preoperatively continued in this status. There was no Fontan failure or mortality. All patients were in New York Heart Association class I or II, although objective cardiopulmonary exercise evaluation in 8 patients showed impaired exercise tolerance. Despite a trend towards prolonged pleural effusion, there was no adverse outcome in the short or intermediate term. Long-term follow-up is required to see whether delayed creation of a Glenn shunt is associated with late disadvantages.
回顾了1999年至2008年间连续进行的33例心外Fontan手术的结果，这些患者大多在婴儿期后进行了初次Glenn分流术。术前，中位氧饱和度为76.2%，平均肺动脉压为10.5 mmHg。Glenn分流术时的中位年龄为4.1岁，Fontan手术时为10岁。这些患者的胸管引流时间比在较小年龄进行Glenn分流术的系列患者更长。所有患者接受华法林治疗1年，然后接受华法林和/或阿司匹林治疗。随访时（中位时间为14个月），无明显心室功能障碍。最后一次随访时的中位氧饱和度为92%。术前处于窦性心律的所有患者均维持该状态。无Fontan手术失败或死亡情况。所有患者均为纽约心脏协会I级或II级，尽管8例患者的客观心肺运动评估显示运动耐量受损。尽管有胸腔积液延长的趋势，但短期或中期无不良后果。需要长期随访以观察延迟进行Glenn分流术是否与晚期不利因素相关。
