Department of Cardiovascular Surgery, 13761Mt. Fuji Shizuoka Children's Hospital, Shizuoka City, Japan.
Asian Cardiovasc Thorac Ann. 2022 Jun;30(5):540-548. doi: 10.1177/02184923211045216. Epub 2021 Sep 15.
Patients with unbalanced pulmonary artery growth resulting from pulmonary coarctation are considered unsuitable candidates for the Fontan procedure. Particularly, patients with right isomerism pose a challenge. We aimed to investigate the use of primary central pulmonary artery plasty at initial palliation in patients with right isomerism.
We recruited 34 right isomerism patients with pulmonary atresia and pulmonary coarctation who underwent modified Blalock-Taussig shunt with or without primary central pulmonary artery plasty between 1998 and 2014. We classified them into the primary central pulmonary artery plasty (group P) and no primary central pulmonary artery plasty (group N) groups. We retrospectively analyzed reintervention for pulmonary artery after initial palliation, difference in size between the left and right pulmonary arteries, overall survival, success of the Fontan procedure.
The group P and group N included 25 and 9 patients, respectively. Five (20%) and six (67%) patients in group P and group N, respectively, required reintervention for pulmonary artery after initial palliation ( = 0.017). No patient underwent reintervention for the pulmonary artery before bidirectional cavopulmonary shunt in group P. There was a significant difference in the bilateral pulmonary artery size balance between the groups before bidirectional cavopulmonary shunt ( = 0.041). The two-lung Fontan procedure was successful in 14 (56%) and 1 (11%) patient in group P and group N.
Primary central pulmonary artery plasty may contribute toward improving the balance in the size of the PA and preclude the need for reintervention for PA.
由于肺动脉狭窄导致的肺动脉生长不平衡的患者被认为不适合接受 Fontan 手术。特别是右位异构的患者更是一个挑战。我们旨在研究在右位异构患者中，在初始姑息治疗时使用主肺动脉成形术的效果。
我们招募了 34 例患有肺动脉闭锁和肺动脉狭窄的右位异构患者，他们在 1998 年至 2014 年期间接受了改良的 Blalock-Taussig 分流术，其中包括或不包括主肺动脉成形术。我们将他们分为主肺动脉成形术（组 P）和无主肺动脉成形术（组 N）两组。我们回顾性分析了初始姑息治疗后肺动脉的再介入治疗、左右肺动脉大小差异、总生存率、Fontan 手术的成功率。
组 P 和组 N 分别包括 25 例和 9 例患者。组 P 和组 N 中分别有 5 例（20%）和 6 例（67%）患者在初始姑息治疗后需要进行肺动脉再介入治疗（ = 0.017）。组 P 中没有患者在双向腔静脉肺动脉分流术前行肺动脉再介入治疗。在双向腔静脉肺动脉分流术之前，两组患者的肺动脉大小平衡存在显著差异（ = 0.041）。在组 P 和组 N 中，14 例（56%）和 1 例（11%）患者的双肺 Fontan 手术成功。
主肺动脉成形术可能有助于改善 PA 的大小平衡，并避免需要再次介入治疗 PA。
