Leung M P, Benson L N, Smallhorn J F, Williams W G, Trusler G A, Freedom R M
Department of Pediatrics University of Toronto, Faculty of Medicine, Canada.
Br Heart J. 1989 Jan;61(1):52-8. doi: 10.1136/hrt.61.1.52.
Among 74 survivors of the Fontan type of operation abnormal cardiac signs were detected in 46 (62%) at postoperative examination. The findings were analysed in relation to the state of the cardiovascular system of these patients. Cyanosis was present in 10 (13.5%) patients. The causes of cyanosis included residual interatrial shunt (six patients), acquired pulmonary arteriovenous fistulas (three patients) and acquired systemic-to-pulmonary vein communication (one patient). Signs of chronic fluid retention were detected in six (8%) patients. In four of them the fluid retention was related to conduit obstruction and in the remaining two it was secondary to severe subaortic stenosis in one and atrioventricular valvar regurgitation in the other. Organic heart murmurs were heard in 29 (39%) patients. The aetiologies of these murmurs were multiple. They included aortic valve regurgitation (eight patients), subaortic stenosis (seven patients), atrioventricular valvar regurgitation (five patients), pulmonary valve regurgitation (five patients), residual Blalock-Taussig shunt (two patients), residual ventricular septal defect (two patients), residual communication in the main pulmonary artery which had been ligated but not divided (one patient), and left ventricular to right atrial shunting (one patient). Cardiac rhythm disturbances of varying aetiology were noted in 23 (31.1%) patients. Sixteen (21%) had supraventricular arrhythmias and seven (9.5%) had conduction abnormalities. The present review suggests that among survivors of the Fontan type of operation abnormal cardiac signs are indicators of residua or sequelae or both of the native cardiovascular anomalies or surgical procedures.
在74例接受Fontan类手术的幸存者中，术后检查发现46例（62%）存在心脏异常体征。对这些检查结果进行了分析，以了解这些患者心血管系统的状况。10例（13.5%）患者存在紫绀。紫绀的原因包括残余房间隔分流（6例患者）、后天性肺动静脉瘘（3例患者）和后天性体肺静脉交通（1例患者）。6例（8%）患者出现慢性液体潴留体征。其中4例的液体潴留与管道梗阻有关，其余2例中，1例继发于严重主动脉瓣下狭窄，另1例继发于房室瓣反流。29例（39%）患者可闻及器质性心脏杂音。这些杂音的病因多种多样。包括主动脉瓣反流（8例患者）、主动脉瓣下狭窄（7例患者）、房室瓣反流（5例患者）、肺动脉瓣反流（5例患者）、残余Blalock-Taussig分流（2例患者）、残余室间隔缺损（2例患者）、已结扎但未切断的主肺动脉残余交通（1例患者）以及左心室向右心房分流（1例患者）。23例（31.1%）患者出现病因各异的心律失常。16例（21%）有室上性心律失常，7例（9.5%）有传导异常。本综述表明，在Fontan类手术的幸存者中，心脏异常体征是先天性心血管异常或手术操作的残余病变或后遗症或两者兼有的指标。
