University of Illinois at Chicago, Advocate Children's Hospital, Oak Lawn, Illinois, USA.
Asian Cardiovasc Thorac Ann. 2021 Oct;29(8):743-750. doi: 10.1177/0218492320984095. Epub 2020 Dec 25.
Patients with antegrade pulmonary blood flow after a bidirectional cavopulmonary shunt (Glenn) may have better pulmonary artery growth. This study evaluated pulmonary artery growth in patients with and without prior additional pulsatile antegrade flow in a Glenn shunt at midterm follow-up after a Fontan procedure.
We reviewed 212 patients who had single-ventricle palliation in a 10-year period;103 (33 in pulsatile group 1 and 70 in nonpulsatile group 2) were selected for analysis. Data on demographics, procedures, perioperative course, and midterm follow-up after the Fontan procedure were compared. Echocardiography data were collected. Pulmonary artery sizes measured at cardiac catheterization and follow-up echocardiograms were used to calculate the Nakata index.
Perioperative details were comparable in both groups, mean pulmonary artery pressure and systemic oxygen saturations were higher in group 1 compared to group 2. Venovenous collaterals were increased in group 1. There was a significant difference in the pre-Fontan and follow-up Nakata index between groups. There was a significant increase in the Nakata index in group 1 between the pre-Glenn and pre-Fontan assessments as well as the Nakata index between the pre-Fontan and midterm follow-up. There was no significant change in the Nakata index in group 2 between assessments.
A pulsatile Glenn shunt is associated with better pulmonary artery growth which continues long after the additional pulsatile flow is eliminated. It is possible that the effects of anterograde pulmonary blood flow on pulmonary artery growth in early life continue long after the Fontan completion.
双向腔静脉肺动脉吻合（Glenn）后存在前向肺血流的患者可能有更好的肺动脉生长。本研究评估了 Fontan 手术后中期随访期间 Glenn 分流术是否存在先前额外搏动性前向血流的患者的肺动脉生长情况。
我们回顾了 10 年内接受单心室姑息治疗的 212 例患者；选择了 103 例患者（搏动组 1 中有 33 例，非搏动组 2 中有 70 例）进行分析。比较了人口统计学、手术程序、围手术期过程以及 Fontan 手术后的中期随访数据。收集了超声心动图数据。使用心脏导管检查和随访超声心动图测量的肺动脉大小来计算 Nakata 指数。
两组的围手术期细节相似，与组 2 相比，组 1 的肺动脉压和全身氧饱和度较高。静脉-静脉侧支在组 1 中增加。两组之间的前 Fontan 和随访 Nakata 指数存在显著差异。组 1 的 Nakata 指数在 Glenn 前和前 Fontan 评估之间以及在 Fontan 前和中期随访之间均有显著增加。组 2 中 Nakata 指数在评估之间没有显著变化。
搏动性 Glenn 分流术与更好的肺动脉生长相关，这种生长在额外搏动性血流消除后仍持续很长时间。在前向肺血流对早期生命中的肺动脉生长的影响在 Fontan 完成后很长时间内可能仍在继续。
