Tunca Şahin Gülhan, Tanıdır İbrahim Cansaran, Gökalp Selman, Güzeltaş Alper
Department of Pediatric Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Turk Gogus Kalp Damar Cerrahisi Derg. 2019 Jun 19;27(3):274-279. doi: 10.5606/tgkdc.dergisi.2019.16398. eCollection 2019 Jul.
This study aims to evaluate the results of transcatheter occlusion of antegrade pulmonary blood flow in children with univentricular heart.
Medical data of a total of seven patients (4 females, 3 males; median age 11.7 years; range, 1 to 24 years) who underwent transcatheter occlusion of the antegrade pulmonary blood flow following Glenn shunt or Fontan operation between September 2014 and January 2017 were retrospectively analyzed. Data including demographic and clinical characteristics of the patients, type of surgery, echocardiographic and cardiac catheterization findings were recorded.
Four patients had a previous pulmonary artery banding operation, while three had pulmonary stenosis. Two patients had facial and upper extremity edema after Glenn operation, one had prolonged pleural effusion, one had prolonged pleural effusion after Fontan operation, and one developed dyspnea and effort intolerance several years after Fontan operation. In two patients, antegrade pulmonary blood flow was occluded to decrease systemic ventricular load before surgery. The Amplatzer Septal Occluder was used in five patients and the Amplatzer Vascular Plug-2 was used in two patients. Two patients developed transient, complete atrioventricular block during the procedure and the procedure was terminated early in one of these patients. Transient hemolysis was observed in one patient following the operation.
Transcatheter occlusion of antegrade pulmonary blood flow is an effective alternative to surgery in patients with hemodynamic compromise after Glenn shunt or Fontan operation.
本研究旨在评估经导管封堵单心室患儿顺行性肺血流的结果。
回顾性分析2014年9月至2017年1月期间，7例（4例女性，3例男性；中位年龄11.7岁；范围1至24岁）在格林分流术或Fontan手术后接受经导管封堵顺行性肺血流的患者的医学数据。记录包括患者的人口统计学和临床特征、手术类型、超声心动图和心导管检查结果等数据。
4例患者曾接受肺动脉环扎术，3例有肺动脉狭窄。2例患者在格林手术后出现面部和上肢水肿，1例有持续性胸腔积液，1例在Fontan手术后有持续性胸腔积液，1例在Fontan手术后数年出现呼吸困难和运动不耐受。2例患者在手术前封堵顺行性肺血流以降低体循环心室负荷。5例患者使用了Amplatzer房间隔封堵器，2例患者使用了Amplatzer血管塞-2。2例患者在手术过程中出现短暂性完全房室传导阻滞，其中1例患者手术提前终止。1例患者术后出现短暂性溶血。
对于格林分流术或Fontan手术后出现血流动力学障碍的患者，经导管封堵顺行性肺血流是一种有效的手术替代方法。
