Labatt Family Heart Centre, Division of Cardiology, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Canada.
Labatt Family Heart Centre, Division of Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Canada.
J Thorac Cardiovasc Surg. 2015 Apr;149(4):1102-10.e2. doi: 10.1016/j.jtcvs.2014.11.080. Epub 2014 Dec 3.
Pulmonary artery growth is an important determinant of outcome in single-ventricle strategies. Higher rates of pulmonary artery intervention have been reported with hybrid-based palliation when compared with Norwood palliation.
We performed a retrospective review of pulmonary artery growth and clinical outcomes in patients undergoing hybrid-based single-ventricle palliation.
The stage I hybrid procedure was performed in 72 patients between 2004 and 2012, of whom 54 were on a Fontan palliative pathway. Thirty-four infants completed stage II, and 20 infants underwent the Fontan operation. The mean diameters of the right pulmonary artery (5.6 ± 1.9 mm) and left pulmonary artery (5.6 ± 2.1 mm) were similar before stage II. After stage II, the right and left pulmonary artery diameters were 8.5 ± 2.1 mm and 5.8 ± 1.3 mm, respectively (P < .001), and after the Fontan operation, these were 8.8 ± 2.0 mm and 6.4 ± 1.1 mm, respectively (P = .002). The mean right pulmonary artery z score was normal throughout, but the left pulmonary artery did not maintain a normal size. The cumulative pulmonary artery intervention rate was 50% at any time after stage II. Fifteen interventions (88%) were performed after stage II (35% during the same hospitalization, 71% <60 days). The most intervened site was the midsection of the left pulmonary artery (41%). Initial pulmonary artery intervention was balloon dilation in 59% of patients and stent implantation in 41% of patients. Half of patients with initial balloon dilation required reintervention.
There is significant risk of left pulmonary artery compromise after the second stage of hybrid palliation associated with a high intervention rate.
肺动脉生长是单心室策略中预后的重要决定因素。与 Norwood 姑息疗法相比，杂交技术为基础的姑息疗法报告了更高的肺动脉介入率。
我们对接受杂交技术为基础的单心室姑息疗法的患者的肺动脉生长和临床结局进行了回顾性研究。
2004 年至 2012 年间，72 例患者接受了 I 期杂交手术，其中 54 例患者接受了 Fontan 姑息治疗。34 例婴儿完成了 II 期手术，20 例婴儿接受了 Fontan 手术。在 II 期手术前，右肺动脉（5.6 ± 1.9 mm）和左肺动脉（5.6 ± 2.1 mm）的平均直径相似。在 II 期手术后，右肺动脉和左肺动脉的直径分别为 8.5 ± 2.1 mm 和 5.8 ± 1.3 mm（P < 0.001），Fontan 手术后，直径分别为 8.8 ± 2.0 mm 和 6.4 ± 1.1 mm（P = 0.002）。整个过程中平均右肺动脉 z 评分正常，但左肺动脉未保持正常大小。在 II 期手术后的任何时候，累计肺动脉介入率为 50%。15 次干预（88%）在 II 期后进行（35%在同一住院期间，71% <60 天）。最常干预的部位是左肺动脉中段（41%）。初始肺动脉介入治疗在 59%的患者中为球囊扩张，在 41%的患者中为支架植入。一半接受初始球囊扩张的患者需要再次干预。
与 Norwood 姑息疗法相比，杂交姑息疗法的第二阶段后左肺动脉狭窄的风险显著增加，介入率也很高。
