Michael E. DeBakey Institute, Texas A&M University, College Station, Texas, USA.
ASAIO J. 2011 May-Jun;57(3):225-30. doi: 10.1097/MAT.0b013e3182178b6e.
Our laboratory has developed an adjustable systemic-pulmonary artery shunt (AS) to provide improved control of pulmonary blood flow (PBF) after neonatal palliation of hypoplastic left heart syndrome (HLHS). Six piglets of 6-10 kg underwent left thoracotomy and placement of a 3.5 mm polytetrafluoroethylene (PTFE) shunt from the left subclavian artery to the left pulmonary artery (LPA). The LPA was ligated at its origin. An AS was placed on the PTFE graft after both anastomoses had been performed. A flow probe was placed on the LPA distal to the shunt insertion. The AS was adjusted every 2 hours (0.1 mm increments over 18 minutes) from fully open to an estimated 60% flow reduction throughout the 44-hour test period, similar to delayed sternal closure (DSC). At any shunt setting, standard deviations of normalized blood flow in each piglet were ranged from 1.34% to 8.05% indicating consistent and stable relationship between shunt setting and flow over the DSC. These data lend strong evidence that the device would perform successfully in a human infant during the DSC. Clinical trials are necessary to determine whether mechanical control of PBF results in improved clinical outcomes.
我们实验室开发了一种可调节的体肺动脉分流器（AS），以在新生儿姑息性左心发育不全综合征（HLHS）后更好地控制肺血流量（PBF）。6 只 6-10 公斤重的小猪接受了左开胸术，并将 3.5 毫米聚四氟乙烯（PTFE）分流器从左锁骨下动脉置于左肺动脉（LPA）。在 LPA 起源处结扎 LPA。在完成两个吻合口后，将 AS 放置在 PTFE 移植物上。在分流器插入部位的 LPA 远端放置流量探头。在整个 44 小时的测试期间，AS 每隔 2 小时（18 分钟内增加 0.1 毫米）从完全打开调整到估计 60%的流量减少，类似于延迟胸骨闭合术（DSC）。在任何分流器设置下，每个小猪的归一化血流量的标准偏差范围为 1.34%至 8.05%，表明分流器设置与 DSC 期间的流量之间存在一致且稳定的关系。这些数据有力地证明，该设备在 DSC 期间将在人类婴儿中成功运行。需要进行临床试验以确定机械控制 PBF 是否会导致临床结果的改善。
