Amato J J, Marbey M L, Bush C, Galdieri R J, Cotroneo J V, Bushong J
Children's Hospital of New Jersey, Newark 07107.
J Thorac Cardiovasc Surg. 1988 Jan;95(1):62-9.
The concept of central shunting in smaller children with the Waterston shunt was initially well accepted. It has been abandoned because of the difficult estimation of lumen size, preferential flow to the right side, and difficulty in the take-down of the shunt. We have replaced the Waterston shunt with a short segment of polytetrafluoroethylene between the ascending aorta and the main pulmonary artery. From January 1979 to December 1986, 190 shunt operations were performed in 157 patients, with the use of 26 classic Blalock-Taussig shunts (13.7%), six Waterston shunts (3.1%), nine Glenn shunts (4.7%), 80 central aortopulmonary polytetrafluoroethylene shunts (42.2%), and 69 modified Blalock-Taussig shunts (36.3%). Polytetrafluoroethylene grafts were used for 149 of the 190 (78.4%) shunts. Overall mortality was 15.2%, with nine early deaths (4.7%) and 20 late deaths (10.5%). Deaths were due to the complex nature of the congenital anomaly or definitive surgical repair. The patients weighed from 1.6 to 48 kg and ages ranged from 1 day to 22 years. We have modified our technique so that (1) graft length is less than 0.5 cm and both ends are beveled, (2) the aortotomy is fashioned with a punch, (3) the center of the polytetrafluoroethylene graft is never clamped, (4) heparin is given during the construction of the shunt, and (5) aspirin (10 mg/kg/day) is administered daily. Patency ranges from 1 to 4 years. We conclude that the polytetrafluoroethylene shunt provides excellent palliation and that the central shunt, in the smaller child and infant, offers the benefits of shunting without distortion of the peripheral pulmonary arteries.
对于较小儿童使用沃特斯顿分流术时的中心分流概念，最初是被广泛接受的。但由于难以估计管腔大小、优先流向右侧以及分流拆除困难，该方法已被摒弃。我们用一段短的聚四氟乙烯在升主动脉和主肺动脉之间取代了沃特斯顿分流术。从1979年1月至1986年12月，157例患者接受了190次分流手术，其中使用了26例经典的布莱洛克 - 陶西格分流术（13.7%）、6例沃特斯顿分流术（3.1%）、9例格伦分流术（4.7%）、80例中心性主动脉 - 肺动脉聚四氟乙烯分流术（42.2%）以及69例改良的布莱洛克 - 陶西格分流术（36.3%）。190次分流术中的149次（78.4%）使用了聚四氟乙烯移植物。总体死亡率为15.2%，其中9例早期死亡（4.7%），20例晚期死亡（10.5%）。死亡原因是先天性畸形的复杂性或确定性手术修复。患者体重从1.6千克至48千克不等，年龄从1天至22岁。我们改进了技术，使得（1）移植物长度小于0.5厘米且两端为斜面；（2）主动脉切口用打孔器制作；（3）聚四氟乙烯移植物的中心从不夹闭；（4）在分流构建过程中给予肝素；（5）每日给予阿司匹林（10毫克/千克/天）。通畅时间为1至4年。我们得出结论，聚四氟乙烯分流术提供了良好的姑息治疗效果，并且对于较小儿童和婴儿，中心分流术在不使外周肺动脉变形的情况下提供了分流的益处。
