Royal Children's Hospital, Melbourne, Australia.
Ann Thorac Surg. 2011 Oct;92(4):1476-82. doi: 10.1016/j.athoracsur.2011.05.105.
Central shunts may be associated with a high rate of thrombosis and pulmonary artery distortion.
Between January 2000 and April 2010, 68 consecutive patients underwent side-to-side aorto-Gore-Tex central shunts (W.L. Gore & Associates, Flagstaff, AZ). Median age at surgery was 31 days (8 to 122). Cardiac morphologies were tetralogy of Fallot (33), pulmonary atresia with collateral dependent lung circulation (20), and other (15). Shunt sizes ranged from 3 to 6 mm. The procedure was performed on cardiopulmonary bypass in 43 patients (63%).
Six patients died during hospital stay (9%) of low output syndrome (3), sepsis (2), and stroke (1). Only one shunt needed early redo. Follow-up was 100% complete. After a median follow-up of 236 days (116 to 340), there were 7 late deaths related to sudden death (3), sepsis (2), reoperation (1), and lack of growth of pulmonary arteries with a patent shunt (1). Repair was completed in 42 patients and still pending in 12. Only one patient needed a late redo shunt (221 days). A larger shunt was performed in 5 patients after a median of 139 days (130 to 258). In the 45 patients who had serial assessment of pulmonary arteries sizes, Nakata index increased from 83 ± 62 mm(2)/m(2) to 153 ± 83 mm(2)/m(2) over a median period of 227 days (146 to 330), with equal growth observed in both pulmonary arteries (p < 0.001).
Central shunts can be performed in neonates and children with minimal risk of shunt occlusion. Side-to-side aorto-Gore-Tex anastomosis seems to reliably warrant shunt patency and harmonious growth of pulmonary arteries.
中心分流可能与高血栓形成率和肺动脉扭曲有关。
2000 年 1 月至 2010 年 4 月，连续 68 例患者接受了侧侧主动脉戈尔-泰克斯中央分流术（W.L.戈尔和联合公司，弗拉格斯塔夫，亚利桑那州）。手术时的中位年龄为 31 天（8 至 122 天）。心脏形态为法洛四联症（33 例）、肺动脉闭锁伴侧支依赖肺循环（20 例）和其他（15 例）。分流器尺寸范围为 3 至 6 毫米。在 43 例患者（63%）中，在体外循环下进行了该手术。
6 例患者在住院期间死亡（9%），其中 3 例死于低心排血量综合征，2 例死于脓毒症，1 例死于中风。只有 1 个分流器需要早期重新手术。随访率为 100%。中位随访 236 天（116 至 340 天）后，有 7 例晚期死亡与猝死（3 例）、脓毒症（2 例）、再次手术（1 例）和肺动脉未发育伴分流器通畅（1 例）有关。42 例患者完成了修复，12 例仍在等待。仅 1 例患者需要进行晚期重新分流（221 天）。5 例患者在中位时间 139 天（130 至 258 天）后进行了更大的分流器手术。在 45 例连续评估肺动脉大小的患者中，Nakata 指数从 83±62mm2/m2 增加到 153±83mm2/m2，中位时间为 227 天（146 至 330 天），两侧肺动脉的生长相等（p<0.001）。
中心分流术可在新生儿和儿童中进行，其分流器阻塞的风险最小。侧侧主动脉戈尔-泰克斯吻合似乎可靠地保证了分流器通畅和肺动脉的协调生长。
