Department of Pediatrics, Heart Institute, Children's Hospital Colorado, Aurora, Colo 80045, USA.
J Thorac Cardiovasc Surg. 2013 Jun;145(6):1485-92. doi: 10.1016/j.jtcvs.2013.01.014. Epub 2013 Feb 8.
Pulmonary artery stenosis is a potential complication after Norwood palliation for hypoplastic left heart syndrome. It is unclear whether the shunt type or position in the Norwood procedure is associated with the risk of the development of pulmonary artery stenosis. We examined the risk of pulmonary artery stenosis and the need for pulmonary artery intervention in children undergoing the Norwood procedure with either the right ventricle to pulmonary artery conduit or modified Blalock-Taussig shunt.
A retrospective review was performed of all patients who underwent the Norwood procedure from January 1, 2003, to September 1, 2011. The data from 100 patients were reviewed, including catheterization and echocardiographic data, right ventricle to pulmonary artery conduit (n = 67, right shunt position in 17 and left in 50), and right ventricle to pulmonary artery (n = 33). The primary outcome measure was the need for operative or catheter-based pulmonary artery intervention.
No patients in the right ventricle to pulmonary artery group required catheterization-based pulmonary artery interventions. Surgical pulmonary arterioplasty was performed frequently and equally in both the right ventricle to pulmonary artery and right ventricle to pulmonary artery groups at the bidirectional Glenn procedure. Catheter-based pulmonary arterioplasty was performed more frequently in the right ventricle to pulmonary artery conduit group, especially when the conduit was positioned to the right side of the neoaorta. These patients had a 12.73 increased odds of a pulmonary artery intervention compared with the left to right ventricle to pulmonary artery conduit (P = .04).
Consistent with a previous multicenter randomized trial, patients who received a right ventricle to pulmonary artery conduit versus a right ventricle to pulmonary artery have a greater risk of requiring pulmonary artery interventions. Patients with right ventricle to pulmonary artery conduit placement to the right underwent a greater number of pulmonary artery interventions but demonstrated overall improved growth of the branch pulmonary arteries compared with the patients receiving a left-sided right ventricle to pulmonary artery conduit.
肺动脉狭窄是左心发育不全综合征患者行 Norwood 姑息术后的潜在并发症。目前尚不清楚 Norwood 手术中的分流类型或位置与肺动脉狭窄的风险之间是否存在关联。我们研究了接受右心室至肺动脉导管或改良 Blalock-Taussig 分流术的 Norwood 手术患儿中肺动脉狭窄的风险和肺动脉干预的需求。
回顾性分析 2003 年 1 月 1 日至 2011 年 9 月 1 日期间接受 Norwood 手术的所有患者的数据。对 100 例患者的资料进行了回顾，包括导管插入术和超声心动图资料、右心室至肺动脉导管（n=67，右分流位置 17 例，左分流位置 50 例）和右心室至肺动脉（n=33）。主要观察指标是需要手术或基于导管的肺动脉介入治疗。
在右心室至肺动脉组中，没有患者需要基于导管的肺动脉介入治疗。在双向 Glenn 手术中，右心室至肺动脉和右心室至肺动脉组均频繁且平等地进行了外科肺动脉成形术。在右心室至肺动脉导管组中，更频繁地进行了基于导管的肺动脉成形术，尤其是当导管置于新主动脉的右侧时。与左至右心室至肺动脉导管组相比，这些患者进行肺动脉介入的可能性增加了 12.73 倍（P=0.04）。
与先前的多中心随机试验一致，接受右心室至肺动脉导管的患者与接受右心室至肺动脉的患者相比，更有可能需要进行肺动脉介入。与接受左侧右心室至肺动脉导管的患者相比，接受右心室至肺动脉导管的患者右位导管放置的肺动脉介入次数更多，但分支肺动脉的总体生长情况有所改善。
