Department of paediatric cardiac surgery, Timone hospital, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France.
Department of paediatric neurology, Timone hospital, AP-HM, 13005 Marseille, France.
Arch Cardiovasc Dis. 2021 Apr;114(4):268-276. doi: 10.1016/j.acvd.2020.11.007. Epub 2021 Jan 25.
The main difference between extreme tetralogy of Fallot (TOF) and pulmonary atresia with ventricle septal defect (PA/VSD) is anterograde pulmonary blood flow (APBF). It is speculated that the association of modified Blalock-Taussig shunt (mBTS) with APBF favours shunt thrombosis, but promotes better pulmonary artery growth.
To compare pulmonary artery growth after mBTS between TOF and PA/VSD.
From 1995 to 2018, 77 mBTS procedures were performed in infants (aged<1 year): 45 for TOF; 32 for PA/VSD. Using a 1/1 propensity score-matched analysis, 38 patients were included (19 per group). Delta Nakata was defined as the difference in the Nakata index before biventricular repair and before mBTS.
After matching, the preoperative Nakata index was similar in the two groups (TOF 101±34 vs. PA/VSD 106±35 mm/m; P=0.75). Age and weight were similar (TOF 24±20 days, 3.3±0.6kg vs. PA/VSD 24±33 days, 3.3±0.9kg; P=0.84 and P=0.77, respectively). There was no difference in rates of in-hospital mortality (TOF 0% vs. PA/VSD 10%; P=0.13) or mBTS thrombosis (TOF 15% vs. PA/VSD 10%; P=0.63). The left and right pulmonary artery diameters at time of biventricular repair were similar (TOF 7.5±2.2 and 6.7±2.1 vs. PA/VSD 8±2.7 and 7.1±2.5mm; P=0.43 and P=0.78, respectively), as were delta Nakata (TOF 112±102 vs. PA/VSD 107±66 mm/m; P=0.89), median age for biventricular repair (P=0.83) and reintervention rates (TOF 10% vs. PA/VSD 15%; P=0.67).
We found no difference in pulmonary artery growth between APBF with mBTS versus mBTS alone. Thus, we could not show an increase in mBTS thrombosis with APBF.
法洛四联症（TOF）和肺动脉闭锁伴室间隔缺损（PA/VSD）的主要区别在于前向肺血流（APBF）。据推测，改良的布莱洛克-陶西格分流术（mBTS）与 APBF 的联合应用有利于发生分流血栓，但促进了更好的肺动脉生长。
比较 TOF 和 PA/VSD 患者 mBTS 术后肺动脉生长情况。
1995 年至 2018 年，对 77 例婴儿（<1 岁）进行了 mBTS 手术：45 例 TOF；32 例 PA/VSD。采用 1/1 倾向评分匹配分析，纳入 38 例患者（每组 19 例）。Delta Nakata 定义为双心室修复前和 mBTS 前 Nakata 指数的差异。
匹配后，两组术前 Nakata 指数相似（TOF 101±34 与 PA/VSD 106±35mm/m；P=0.75）。年龄和体重相似（TOF 24±20 天，3.3±0.6kg 与 PA/VSD 24±33 天，3.3±0.9kg；P=0.84 和 P=0.77）。院内死亡率（TOF 0%与 PA/VSD 10%；P=0.13）或 mBTS 血栓形成率（TOF 15%与 PA/VSD 10%；P=0.63）无差异。双心室修复时左、右肺动脉直径相似（TOF 7.5±2.2 和 6.7±2.1 与 PA/VSD 8±2.7 和 7.1±2.5mm；P=0.43 和 P=0.78），Delta Nakata 也相似（TOF 112±102 与 PA/VSD 107±66mm/m；P=0.89），双心室修复的中位年龄（P=0.83）和再介入率（TOF 10%与 PA/VSD 15%；P=0.67）相似。
我们发现 mBTS 联合 APBF 与单纯 mBTS 相比，肺动脉生长无差异。因此，我们不能证明 APBF 增加了 mBTS 血栓形成的风险。
