Kitaichi Takashi, Sugano Mikio, Kinoshita Hajime, Nakayama Taisuke, Kurobe Hirotsugu, Kanbara Tamotsu, Fujimoto Eiki, Kitagawa Tetsuya
Department of Cardiovascular Surgery, The University of Tokushima, Tokushima, Japan.
Kyobu Geka. 2014 Apr;67(4):274-7.
Although the right-ventricle to pulmonary artery( RV-PA) shunt as a source of pulmonary blood supply of Norwood procedure has improved early outcomes, disadvantages including right ventricular dysfunction or arrhythmias have been reported. So it has been still remained controversial whether BT shunt or RV-PA conduit should be selected. We examined the influence of Blalock-Taussig( BT) shunt size on regulation of the pulmonary blood flow in experimental model of a univentricular heart to determine the specific guidelines regarding suitable shunt size in the Norwood procedure. The canine univentricular heart model with the ratio of shunt size to body weight (SS/BW) of 0.8 to 1.1 showed significant negative correlation between the pulmonary/systemic blood flow ratio( Qp/Qs)and arterial PCo2, but those with SS/BW of 1.1 to 1.4 did not. Similar phenomena were shown with the grouped data on relationship between the Qp/Qs and inspired oxygen fraction. These findings imply that when SS/BW is 0.8 to 1.1, the Qp/Qs is controllable by physiologic respiratory manipulations. In the context of our clinical experiences, SS/BW of 0.9 to 1.0 is considered a useful index for suitable BT shunt in the Norwood procedure.
尽管作为诺伍德手术肺血供来源的右心室至肺动脉（RV-PA）分流改善了早期预后，但包括右心室功能障碍或心律失常在内的缺点也有报道。因此，对于应选择体肺分流术（BT分流术）还是RV-PA管道仍存在争议。我们在单心室心脏实验模型中研究了Blalock-Taussig（BT）分流大小对肺血流调节的影响，以确定诺伍德手术中合适分流大小的具体指南。分流大小与体重之比（SS/BW）为0.8至1.1的犬单心室心脏模型显示，肺/体血流比（Qp/Qs）与动脉血二氧化碳分压（PCO₂）之间存在显著负相关，但SS/BW为1.1至1.4的模型则不存在这种相关性。关于Qp/Qs与吸入氧分数之间关系的分组数据也显示了类似现象。这些发现表明，当SS/BW为0.8至1.1时，Qp/Qs可通过生理性呼吸操作进行控制。结合我们的临床经验，SS/BW为0.9至1.0被认为是诺伍德手术中合适BT分流的有用指标。
