Chin A J, Barber G, Helton J G, Alboliras E T, Aglira B A, Pigott J D, Norwood W I
Division of Cardiology, Children's Hospital of Philadelphia, Pennsylvania 19104.
Am J Cardiol. 1988 Sep 1;62(7):435-8. doi: 10.1016/0002-9149(88)90973-3.
Transection of the main pulmonary artery and end-to-side anastomosis of the proximal pulmonary artery to the ascending aorta has been increasingly used in palliative surgery for cardiac malformations such as single ventricle with small outlet foramen (bulboventricular foramen) and hypoplastic left-heart syndrome. To evaluate pulmonary valve competence after this operation, we used color Doppler flow mapping to examine 45 survivors of pulmonary artery-to-ascending aorta anastomosis a median of 202 days postoperatively. Of 37 patients with hypoplastic left heart syndrome, mild regurgitation was detected in 9 (24%) and moderate regurgitation in 1 (3%). Of 8 with other lesions, mild regurgitation was observed in 2 and moderate regurgitation in 1. Seven of 11 patients imaged greater than or equal to 12 months postoperatively had regurgitation. In summary, one-fourth of survivors developed mild pulmonary regurgitation. Its presence should not be considered a contraindication to eventual application of Fontan's principle, although further follow-up appears warranted because the long-term fate of pulmonary valve function is not yet known.
主肺动脉横断以及近端肺动脉与升主动脉端侧吻合术已越来越多地用于心脏畸形的姑息性手术，如单心室伴小流出孔（球室孔）和左心发育不全综合征。为评估该手术后的肺动脉瓣功能，我们使用彩色多普勒血流显像对45例肺动脉与升主动脉吻合术的幸存者进行了检查，术后中位时间为202天。在37例左心发育不全综合征患者中，9例（24%）检测到轻度反流，1例（3%）检测到中度反流。在8例患有其他病变的患者中，2例观察到轻度反流，1例观察到中度反流。11例术后成像时间大于或等于12个月的患者中有7例存在反流。总之，四分之一的幸存者出现轻度肺动脉反流。尽管鉴于肺动脉瓣功能的长期转归尚不清楚，似乎有必要进行进一步随访，但肺动脉反流的存在不应被视为最终应用Fontan原则的禁忌证。
