Ishidou Motonori, Ota Keisuke, Watanebe Kentaro, Koshiyama Hiroshi, Kanno Kazuyoshi, Ito Hiroki, Murata Masaya, Hirose Keiichi, Ikai Akio, Sakamoto Kisaburo
Department of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan.
Eur J Cardiothorac Surg. 2020 Jul 1;58(1):177-185. doi: 10.1093/ejcts/ezaa035.
Patients with unbalanced pulmonary artery (PA) growth and decreased unilateral pulmonary circulation are considered unsuitable candidates for the Fontan procedure. Following our previous study on the utility of intrapulmonary-artery septation for patients with PA hypoplasia, we investigated its use in patients with pulmonary venous obstruction (PVO).
We recruited 42 patients who underwent intrapulmonary-artery septation for unilateral PA hypoplasia and/or PVO between 1998 and 2018 and classified them into no PVO or PVO group. We analysed overall survival, success of the Fontan procedure and data from catheterization and echocardiography. In PVO, we evaluated the functional lung area before the Fontan procedure and the relevance of this parameter to operative outcomes.
The PVO and no-PVO group included 24 and 18 patients, respectively. One patient in the no-PVO and 6 patients in the PVO group died during follow-up; this difference was statistically significant (log-rank P = 0.040). In the no-PVO group, 15 (83%) patients achieved two-lung Fontan circulation. In the PVO group, 12 (50%) patients achieved two-lung Fontan circulation. Multivariate analysis revealed that functional lung area and shunt size [significantly larger in patients with functional lung area ≥50% in affected lung (P = 0.040)] were significant factors for successful two-lung Fontan procedure (P = 0.030).
Intrapulmonary-artery septation may contribute to increase functional lung area after PVO release to establish two-lung Fontan circulation in patients with PVO who have unbalanced PA growth and/or decreased unilateral pulmonary circulation.
肺动脉（PA）生长不平衡且单侧肺循环减少的患者被认为不适合进行Fontan手术。继我们之前关于肺内动脉分隔术对PA发育不全患者效用的研究之后，我们调查了其在肺静脉梗阻（PVO）患者中的应用。
我们招募了1998年至2018年间接受肺内动脉分隔术治疗单侧PA发育不全和/或PVO的42例患者，并将他们分为无PVO组或PVO组。我们分析了总生存率、Fontan手术的成功率以及心导管检查和超声心动图数据。对于PVO，我们评估了Fontan手术前的功能性肺面积以及该参数与手术结果的相关性。
PVO组和无PVO组分别包括24例和18例患者。无PVO组有1例患者和PVO组有6例患者在随访期间死亡；这种差异具有统计学意义（对数秩检验P = 0.040）。在无PVO组中，15例（83%）患者实现了双肺Fontan循环。在PVO组中，12例（50%）患者实现了双肺Fontan循环。多变量分析显示，功能性肺面积和分流大小[在患侧肺功能性肺面积≥50%的患者中显著更大（P = 0.040）]是成功进行双肺Fontan手术的重要因素（P = 0.030）。
肺内动脉分隔术可能有助于在PVO解除后增加功能性肺面积，从而为PA生长不平衡和/或单侧肺循环减少的PVO患者建立双肺Fontan循环。
