Kusuhara K, Miki S, Ueda Y, Ohkita Y, Tahata T, Komeda M
Ann Thorac Surg. 1987 Aug;44(2):128-34. doi: 10.1016/s0003-4975(10)62021-8.
An aorta-pulmonary artery shunt with an expanded polytetrafluoroethylene (Gore-Tex) tube graft (3 to 6 mm in diameter) was done in 33 cyanotic patients with complex congenital heart disease. The patients ranged from 14 days to 22 years old. In 28, the shunt flow (QB) was measured, and the optimal QB and graft size were determined. Nine patients had severe heart failure because of an excessively large shunt. Seven of these patients died, 5 early and 2 late after operation. The QBS in these 9 patients were extremely high; the QB index and the ratio of shunt flow to systemic flow (QB/QS) were 3.86 +/- 0.91 L/min/m2 (mean +/- standard deviation) and 52.4 +/- 9.7%, respectively. The QB index and the QB/QS of patients without severe cardiac failure were 1.49 +/- 0.92 L/min/m2 and 27.2 +/- 11.4%, respectively. In conclusion, the QB index, the QB/QS, or both should be maintained in the range of 1.6 to 2.4 L/min/m2 and 30 to 40%, respectively. In infants, however, it is advisable to control the flow at less than the range just given. Analysis of graft size in relation to body weight (BW, in kilograms) and body surface area (BSA, in square meters) showed that the optimal diameter (D, in millimeters) could be calculated by the following formulas: D = 1.88 In(BW) + 1.8 (r = .86) D = 0.87 In(BSA) + 5.3 (r = .73).
对33例患有复杂先天性心脏病的紫绀型患者进行了采用膨体聚四氟乙烯（戈尔特斯）人工血管（直径3至6毫米）的主动脉-肺动脉分流术。患者年龄从14天至22岁不等。对其中28例患者测量了分流血流量（QB），并确定了最佳QB和人工血管尺寸。9例患者因分流量过大而出现严重心力衰竭。其中7例患者死亡，5例于术后早期死亡，2例于术后晚期死亡。这9例患者的QBS极高；QB指数及分流血流量与体循环血流量之比（QB/QS）分别为3.86±0.91升/分钟/平方米（均值±标准差）和52.4±9.7%。无严重心力衰竭患者的QB指数及QB/QS分别为1.49±0.92升/分钟/平方米和27.2±11.4%。总之，QB指数、QB/QS或二者均应分别维持在1.6至2.4升/分钟/平方米及30%至40%的范围内。然而，对于婴儿，建议将流量控制在略低于上述范围。对人工血管尺寸与体重（BW，千克）和体表面积（BSA，平方米）关系的分析表明，最佳直径（D，毫米）可通过以下公式计算：D = 1.88 ln(BW) + 1.8（r = 0.86）；D = 0.87 ln(BSA) + 5.3（r = 0.73）。
