Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, California.
Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, California.
Ann Thorac Surg. 2019 Jul;108(1):154-159. doi: 10.1016/j.athoracsur.2019.02.053. Epub 2019 Mar 27.
Pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (MAPCAs) is a rare form of congenital heart disease characterized by the entirety of pulmonary blood flow originating from systemic vessels. This study measured the residual collateral flow after harvesting of the MAPCAs for surgical repair.
The study enrolled 32 patients with pulmonary atresia with ventricular septal defect and MAPCAs who were undergoing their first surgical procedure. The median age was 6.8 months, and median weight was 5.7 kg. The patients had a mean of 4.2 ± 0.7 MAPCAs. The cardiopulmonary bypass circuit was modified to contain a diversion loop in the left ventricular vent system to accurately measure residual collateral flow. During the period of aortic cross-clamp (for ventricular septal defect repair), the diversion loop was opened for 1-minute intervals, and the residual collateral flow collected. The systemic perfusion temperature was 25° and flow rate was 100 mL · kg · min.
The mean residual collateral flow was 5.5 mL · kg · min (range, 0.8 to 15.2 mL · kg · min). The corresponding calculated pulmonary blood flow-to-systemic blood flow ratio values ranged from 1.01 to 1.36. There was a significant correlation between residual collateral flow and preoperative saturation (p < 0.05).
The data demonstrate a wide range of residual collateral flow values after harvesting of the MAPCAs. The amount of residual collateral flow was correlated with preoperative saturation. These results suggest that some patients at the higher end of this spectrum may require adjustments in pump flow to assure adequate systemic perfusion.
肺动脉闭锁伴室间隔缺损和主要体肺侧支动脉（MAPCAs）是一种罕见的先天性心脏病，其特征是所有肺血流均来自体循环。本研究测量了 MAPCAs 切除后用于手术修复的残余侧支血流。
本研究纳入了 32 例接受首次手术的肺动脉闭锁伴室间隔缺损和 MAPCAs 患者。患者的中位年龄为 6.8 个月，体重中位数为 5.7kg。患者平均有 4.2±0.7 条 MAPCAs。心肺转流回路进行了修改，在左心室通气系统中包含一个分流环，以准确测量残余侧支血流。在主动脉阻断期间（用于室间隔缺损修复），打开分流环 1 分钟间隔，收集残余侧支血流。全身灌注温度为 25°C，流量为 100mL·kg·min。
平均残余侧支血流为 5.5mL·kg·min（范围为 0.8 至 15.2mL·kg·min）。相应的计算出的肺血流量与体血流量比值范围为 1.01 至 1.36。残余侧支血流与术前饱和度之间存在显著相关性（p<0.05）。
这些数据表明，在切除 MAPCAs 后，残余侧支血流值的范围很广。残余侧支血流的量与术前饱和度相关。这些结果表明，该范围内较高端的一些患者可能需要调整泵流量以确保足够的全身灌注。
