Qureshi S A, Richheimer R, McKay R, Arnold R
Cardiac Unit, Royal Liverpool Children's Hospital.
Br Heart J. 1990 Oct;64(4):272-6. doi: 10.1136/hrt.64.4.272.
Doppler echocardiography was used to evaluate blood flow in the pulmonary artery in 14 patients 2 to 42 months (mean (SD) 17 (12) months) after a modified Fontan operation incorporating a direct atriopulmonary anastomosis. Preoperatively six patients had tricuspid atresia, six had a double inlet left ventricle, and two had pulmonary atresia with an intact ventricular septum. The postoperative rhythm was sinus in 11 patients, junctional in one, ventricular pacing in one, and atrioventricular sequential pacing in one. In one patient the Doppler trace was unsatisfactory for analysis. In all patients forward flow in the pulmonary artery had biphasic peaks related to both atrial and ventricular contraction. The mean (SD) peak flow velocity that was synchronous with atrial contraction was 80 (30) cm/s and that synchronous with ventricular contraction was 74 (23) cm/s. The atrial contribution to total pulmonary artery flow, assessed by velocity-time integrals, varied between 22% and 73% (mean (SD) 45 (14)%). In patients with tricuspid atresia the mean (SD) peak flow velocity with atrial contraction was 90 (27) cm/s and that with ventricular contraction was mean (SD) 68 (24) cm/s. In patients with double inlet left ventricle the mean (SD) peak flow velocity was 67 (36) cm/s with atrial contraction and 80 (25) cm/s with ventricular contraction. The atrial contribution to total pulmonary blood flow in patients with tricuspid atresia was significantly higher (53 (11)%) than in those with double inlet left ventricle (37 (14)%). Pulmonary artery flow after modified Fontan operation was biphasic and was related to both atrial and ventricular contraction. The atrial contribution to pulmonary blood flow is greater in patients with tricuspid atresia than in those with a double inlet left ventricle. The mechanism of the second peak related to ventricular contraction is unknown.
采用多普勒超声心动图评估了14例患者在改良Fontan手术（采用直接心房 - 肺动脉吻合术）后2至42个月（平均（标准差）17（12）个月）肺动脉内的血流情况。术前，6例患者为三尖瓣闭锁，6例为双入口左心室，2例为室间隔完整的肺动脉闭锁。术后，11例患者的心律为窦性，1例为交界性心律，1例为心室起搏心律，1例为房室顺序起搏心律。1例患者的多普勒描记图因无法分析而未采用。所有患者肺动脉内的前向血流均有与心房和心室收缩相关的双相峰值。与心房收缩同步的平均（标准差）峰值流速为80（30）cm/s，与心室收缩同步的为74（23）cm/s。通过速度 - 时间积分评估，心房对肺动脉总血流的贡献在22%至73%之间（平均（标准差）45（14）%）。三尖瓣闭锁患者心房收缩时的平均（标准差）峰值流速为90（27）cm/s，心室收缩时为平均（标准差）68（24）cm/s。双入口左心室患者心房收缩时的平均（标准差）峰值流速为67（36）cm/s，心室收缩时为80（25）cm/s。三尖瓣闭锁患者心房对肺总血流量的贡献显著高于双入口左心室患者（53（11）%比37（14）%）。改良Fontan手术后的肺动脉血流呈双相，与心房和心室收缩均有关。三尖瓣闭锁患者心房对肺血流的贡献大于双入口左心室患者。与心室收缩相关的第二个峰值的机制尚不清楚。
