Thatte Nikhil, Dimas Vivian, Nugent Alan, Zellers Thomas, Forbess Joseph, Zabala Luis, Zhang Song, Veeram Reddy Surendranath R
Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Pediatrics, Children's Medical Center, University of Texas Southwestern, Dallas, Texas, USA.
Ann Pediatr Cardiol. 2020 Oct-Dec;13(4):327-333. doi: 10.4103/apc.APC_154_19. Epub 2020 Sep 21.
There are no established criteria to decide suitability for Fontan fenestration closure. Our institution has the following criteria: an unobstructed Fontan pathway with no significant decompressing venovenous collaterals, baseline Fontan pressure ≤15 mmHg, baseline cardiac index ≥2 L/min/m, and a decrease in cardiac index ≤20% with test occlusion of the fenestration.
The objective of the study was to review midterm outcomes following device closure of Fontan fenestration using institutional criteria.
A retrospective review was performed of patients who underwent catheterization with prior fenestrated Fontan procedure between May 2005 and January 2015. Patients were classified as those who underwent successful closure (A), had closure deferred due to failure to meet criteria (B), or were not referred for closure (C).
There were 42 patients in Group A, 10 in Group B, and 150 in Group C. The mean Fontan pressure increased from 13.1 ± 2.1 to 14.5 ± 2.1mmHg in Group A and 14.6 ± 1.5 to 15.7 ± 2.2 mmHg in Group B ( = not significant). With test occlusion, cardiac index fell by 18.12% ± 15.68% in Group A and 33.75% ± 14.98% in Group B ( = 0.019). At a median of 46 month follow-up, oxygen saturation increased significantly from 85.15% ± 6.29% at baseline to 94.6% ± 4.43% ( < 0.001) in Group A but with no statistically significant difference in the rates of plastic bronchitis, protein-losing enteropathy, stroke, or heart transplantation between the three groups.
Using institutional criteria, transcatheter device closure of Fontan fenestration was followed by significant increase in oxygen saturations and no statistically significant difference in morbidity or mortality between closure and nonclosure groups.
目前尚无确定Fontan开窗关闭术适用性的既定标准。我院制定了以下标准:Fontan通路通畅,无明显减压性腔静脉侧支循环,基线Fontan压力≤15 mmHg,基线心脏指数≥2 L/min/m²,且在测试性封堵开窗时心脏指数降低≤20%。
本研究的目的是使用我院标准回顾Fontan开窗封堵装置术后的中期结果。
对2005年5月至2015年1月期间接受过带开窗Fontan手术的患者进行导管检查的情况进行回顾性分析。患者分为成功封堵组(A组)、因不符合标准而推迟封堵组(B组)或未被转诊进行封堵组(C组)。
A组有42例患者,B组有10例,C组有150例。A组的平均Fontan压力从13.1±2.1 mmHg升至14.5±2.1 mmHg,B组从14.6±1.5 mmHg升至15.7±2.2 mmHg(差异无统计学意义)。在测试性封堵时,A组心脏指数下降18.12%±15.68%,B组下降33.75%±14.98%(P = 0.019)。在中位随访46个月时,A组氧饱和度从基线时的85.15%±6.29%显著升至94.6%±4.43%(P < 0.001),但三组间在塑料支气管炎、蛋白丢失性肠病、中风或心脏移植发生率方面无统计学显著差异。
使用我院标准,Fontan开窗经导管装置封堵术后氧饱和度显著提高,封堵组与未封堵组在发病率或死亡率方面无统计学显著差异。