Özyüksel Arda, Şimşek Baran, Özden Ömer, Demiroluk Şener, Saygı Murat, Bilal Mehmet Salih
Department of Cardiovascular Surgery, Biruni University, Istanbul, Turkey.
Department of Cardiovascular Surgery, Medicana International Hospital, Istanbul, Turkey.
J Card Surg. 2021 Mar;36(3):941-949. doi: 10.1111/jocs.15293. Epub 2021 Jan 8.
Several factors affect the long-term outcome of Fontan procedure, but a high pulmonary artery pressure is still one of the most important limitation for proceeding to a Fontan circulation. Herein, we present our experience in Fontan patients with high preoperative pulmonary artery pressures.
A retrospective analysis was performed to evaluate Fontan patients with a preoperative pulmonary artery pressure >15 mmHg between 2009 and 2020. Sixteen patients were operated on with a mean preoperative pulmonary artery pressure of 17.5 ± 2.1 mmHg.
Mean age at the time of Fontan procedure was 7.8 ± 5.6 years. All the patients had stage 2 cavopulmonary anastomosis before Fontan completion, with a mean interstage period of 4 ± 2.6 years. Fontan completion was achieved with a polytetrafluorethylene tubular conduit, two of which were intra-extracardiac. Fenestration was performed in five (31%) cases. Postoperative pulmonary artery pressures and arterial oxygen saturation levels were 11.2 ± 2.8 and 97.8 ± 2 mmHg, respectively. Mean duration of pleural drainage was 3.9 ± 5.3 days. Any morbidity and mortality were not encountered during a mean follow-up period of 4.8 ± 7.7 years.
The midterm results of stage 3 Fontan completion in patients with pulmonary artery >15 mmHg are encouraging. Not only the mean pulmonary artery pressure but also the pulmonary vascular resistance may be helpful in order to identify the high risk patients before Fontan completion.
多种因素影响Fontan手术的长期预后，但高肺动脉压力仍是建立Fontan循环的最重要限制因素之一。在此，我们介绍我们在术前肺动脉压力较高的Fontan患者中的经验。
进行回顾性分析，以评估2009年至2020年间术前肺动脉压力>15 mmHg的Fontan患者。16例患者接受了手术，术前平均肺动脉压力为17.5±2.1 mmHg。
Fontan手术时的平均年龄为7.8±5.6岁。所有患者在完成Fontan手术前均进行了二期腔肺吻合，平均间期为4±2.6年。使用聚四氟乙烯管状导管完成Fontan手术，其中2例为心内外联合。5例（31%）进行了开窗术。术后肺动脉压力和动脉血氧饱和度水平分别为11.2±2.8和97.8±2 mmHg。胸腔引流的平均持续时间为3.9±5.3天。在平均4.8±7.7年的随访期内未出现任何并发症和死亡。
肺动脉压力>15 mmHg的患者进行三期Fontan手术的中期结果令人鼓舞。在完成Fontan手术前，不仅平均肺动脉压力，而且肺血管阻力可能有助于识别高危患者。
