Fang Minhua, Wang Huishan, Jin Yan, Wang Zengwei, Wang Zhenlong, Zhang Chunzhen
Department of Cardiovascular Surgery, Northern Hospital, Shenyang City, Liaoning Province, People's Republic of China.
Thorac Cardiovasc Surg. 2014 Apr;62(3):211-5. doi: 10.1055/s-0033-1354247. Epub 2013 Sep 24.
To evaluate the development of pulmonary arteries (PAs) in patients with pulmonary atresia, ventricular septal defect, and diminutive PAs by using a central end-to-side shunt.
A total of 103 consecutive patients (71 male and 32 female) with pulmonary atresia, ventricular septal defect, and diminutive PAs received a central end-to-side shunt between PA and aorta from May 2004 to December 2010. The age and weight ranged between 2 to 86 months and 2.5 to 21.5 kg, respectively. Overall 79 patients with main PA diameters less than 4 mm received a central end-to-side shunt between PA and aorta, and 24 patients with main PAs absence received a modified central shunt between PA branches and aorta.
There were no deaths during operation and follow-up. Compared with preoperative measures, total PA index increased from mean value 68.8 ± 11.4 mm2/m2 to 129.1 ± 24.9 mm2/m2 (p < 0.001). The increased PA index change at the time of 6 months or final repair after shunt completion was 87.7 ± 27.4% (27-150%). By multivariate regression analysis, age at shunt, shunt procedure, and number of major aortopulmonary collateral arteries were correlated with increasing PA index change.
The central end-to-side shunt promoted sufficient growth of the diminutive central PAs, especially in infant patients. Due to the risk of a distortion of pulmonary branches, the authors interposed a modified procedure for patients with main PAs absence by anastomosis of left PA and right PA directly in an end-to-side fashion to the both lateral wall of ascending aorta. It is technically easy to perform, warrants low risk of shunt thrombosis, and flow restriction in the early postoperative period.
通过使用中心端侧分流术评估肺动脉闭锁、室间隔缺损及细小肺动脉患者的肺动脉（PA）发育情况。
2004年5月至2010年12月，共有103例连续性肺动脉闭锁、室间隔缺损及细小肺动脉患者（男71例，女32例）接受了PA与主动脉之间的中心端侧分流术。年龄范围为2至86个月，体重范围为2.5至21.5千克。总体而言，79例主PA直径小于4毫米的患者接受了PA与主动脉之间的中心端侧分流术，24例无主PA的患者接受了PA分支与主动脉之间的改良中心分流术。
手术及随访期间无死亡病例。与术前测量值相比，总PA指数从平均值68.8±11.4平方毫米/平方米增加至129.1±24.9平方毫米/平方米（p<0.001）。分流完成后6个月或最终修复时PA指数增加变化为87.7±27.4%（27 - 150%）。通过多因素回归分析，分流时的年龄、分流手术及主要主肺动脉侧支动脉数量与PA指数增加变化相关。
中心端侧分流术促进了细小中心PA的充分生长，尤其是在婴儿患者中。由于存在肺分支扭曲的风险，作者对无主PA的患者采用了改良手术，即将左PA和右PA直接以端侧方式吻合至升主动脉的两侧壁。该手术操作技术上简便，分流血栓形成风险低，术后早期血流受限风险低。
