Turner Mariel E, Richmond Marc E, Quaegebeur Jan M, Shah Amee, Chen Jonathan M, Bacha Emile A, Vincent Julie A
Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York-Presbyterian, 3959 Broadway, 2 North, New York, NY 10032, USA.
Pediatr Cardiol. 2013 Apr;34(4):924-30. doi: 10.1007/s00246-012-0576-1. Epub 2012 Nov 15.
For patients with hypoplastic left heart syndrome who have undergone the Norwood procedure with a right ventricle-pulmonary artery (RV-PA) shunt, the shunt can either be removed or left intact at the time of the stage 2 procedure. This study aimed to determine the effects of an intact shunt on pulmonary artery growth and clinical outcomes after the stage 2 procedure. A retrospective review of patients who underwent Norwood with an RV-PA shunt from 2005 to 2010 was performed. Catheterization data, echocardiographic data, postoperative outcome variables, and mortality data were collected. Pulmonary artery size was measured at pre-stage 2 and pre-Fontan catheterizations using the Nakata Index and the McGoon Ratio. Of the 68 patients included in the study, 48 had the shunt removed at the time of stage 2 (group 1), and 20 had the shunt left intact (group 2). The two groups did not differ in terms of pre-stage 2 hemodynamics or pulmonary artery size. After stage 2, group 2 had higher oxygen saturations. The two groups did not differ regarding duration of chest tube drainage, length of hospital stay, need for unplanned interventions, or mortality. Before Fontan, the group 2 patients had higher superior vena cava (SVC) pressures and more venovenous collaterals closed. There was increased pulmonary artery growth between the pre-stage 2 and pre-Fontan catheterizations in group 2 using both the Nakata Index (+148.5 vs -52.4 mm(2)/m(2); p = 0.01) and the McGoon Ratio (+0.36 vs +0.01; p = 0.01). These findings indicate that patients with an intact RV-PA shunt after stage 2 have greater pulmonary artery growth than patients with the shunt removed, with no increased risk of complications.
对于接受了带有右心室 - 肺动脉（RV - PA）分流的诺伍德手术的左心发育不全综合征患者，在二期手术时，分流可以被移除，也可以保持完整。本研究旨在确定完整分流对二期手术后肺动脉生长和临床结局的影响。对2005年至2010年接受带RV - PA分流的诺伍德手术的患者进行了回顾性研究。收集了导管检查数据、超声心动图数据、术后结局变量和死亡率数据。在二期手术前和Fontan手术前的导管检查中，使用中田指数和麦戈恩比率测量肺动脉大小。在纳入研究的68例患者中，48例在二期手术时移除了分流（第1组），20例保留了分流（第2组）。两组在二期手术前的血流动力学或肺动脉大小方面没有差异。二期手术后，第2组的氧饱和度更高。两组在胸管引流持续时间、住院时间、计划外干预需求或死亡率方面没有差异。在Fontan手术前，第2组患者的上腔静脉（SVC）压力更高，更多的腔静脉侧支闭合。使用中田指数（+148.5 vs -52.4 mm²/m²；p = 0.01）和麦戈恩比率（+0.36 vs +0.01；p = 0.01），第2组在二期手术前和Fontan手术前的导管检查之间肺动脉生长增加。这些发现表明，二期手术后保留RV - PA分流的患者比移除分流的患者有更大的肺动脉生长，且并发症风险没有增加。
