Wilson N J, Seear M D, Taylor G P, LeBlanc J G, Sandor G G
Department of Pediatrics, University of British Columbia, Vancouver, Canada.
J Thorac Cardiovasc Surg. 1990 Mar;99(3):460-8.
A retrospective review was made of 59 open lung biopsy specimens taken between 1984 and 1988 from children with congenital heart disease who were at risk for pulmonary vascular disease. Thirty-seven patients (ranging in age from 3.5 months to 23 years; median age, 14 months) had a primary left-to-right shunt (group A) and 22 patients (ages 1 to 15 years) had palliated cyanotic heart disease (group B). Forty-five of the lung biopsy specimens were requested as frozen sections. In both groups lung biopsy specimens were graded by the Heath-Edwards classification and correlated against preoperative hemodynamic data and outcome. In group A patients, carefully measured pulmonary vascular resistance and pulmonary/systemic vascular resistance ratio were reliable indicators of the structural state of the pulmonary vascular bed, obviating the need for routine lung biopsy. Pulmonary/systemic vascular resistance ratios greater than 0.45 accurately predicted all patients with irreversible pulmonary vascular disease, and pulmonary vascular resistance greater than 7 units.m2 accurately predicted all but one case of disease. Reversibility of pulmonary vascular changes is not synonymous with immediate postoperative survival: Fatal postoperative pulmonary hypertensive crises occurred in the presence of reversible pulmonary disease. Of those considered for the Fontan procedure, a mean pulmonary artery pressure less than 30 mm Hg and pulmonary vascular resistance less than 3 units.m2 correlated with Heath-Edwards grade I or normal lung biopsy results. In 36% of group B patients, reliable assessment of pulmonary vascular resistance could not be made, indicating a possible need for open lung biopsy procedures. When lung biopsy procedures were used as an isolated procedure, they were more dangerous (20% mortality, 13% morbidity) than previously reported. Intraoperative frozen sections are not adequate to accurately assess pulmonary vascular changes (9% error); serial paraffin sections are required.
对1984年至1988年间取自患有先天性心脏病且有患肺血管疾病风险的儿童的59份开放性肺活检标本进行了回顾性研究。37例患者（年龄从3.5个月至23岁；中位年龄为14个月）患有原发性左向右分流（A组），22例患者（年龄1至15岁）患有姑息性紫绀型心脏病（B组）。45份肺活检标本被要求制成冰冻切片。两组的肺活检标本均按照希思 - 爱德华兹分类法进行分级，并与术前血流动力学数据及预后情况进行关联分析。在A组患者中，仔细测量的肺血管阻力及肺/体循环血管阻力比值是肺血管床结构状态的可靠指标，无需进行常规肺活检。肺/体循环血管阻力比值大于0.45能准确预测所有患有不可逆肺血管疾病的患者，肺血管阻力大于7单位·m²能准确预测除1例之外的所有病例。肺血管变化的可逆性并不等同于术后即刻存活：在存在可逆性肺部疾病的情况下发生了致命的术后肺动脉高压危象。在考虑进行Fontan手术的患者中，平均肺动脉压小于30 mmHg且肺血管阻力小于3单位·m²与希思 - 爱德华兹I级或正常肺活检结果相关。在B组36%的患者中，无法对肺血管阻力进行可靠评估，这表明可能需要进行开放性肺活检。当将肺活检作为一项单独操作时，其危险性（死亡率20%，发病率13%）高于先前报道。术中冰冻切片不足以准确评估肺血管变化（误差9%）；需要连续石蜡切片。
