Division of Cardiothoracic Surgery, Department of Surgery, University of Southern California, Los Angeles, California; Department of Pediatrics, University of Southern California, Los Angeles, California; Heart Institute, Children's Hospital of Los Angeles, Los Angeles, California.
Division of Cardiology, University of Southern California, Los Angeles, California; Department of Pediatrics, University of Southern California, Los Angeles, California; Heart Institute, Children's Hospital of Los Angeles, Los Angeles, California.
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2022;25:11-18. doi: 10.1053/j.pcsu.2022.04.003.
Despite significant improvements in the management of Fontan circulation in patients with single ventricle physiology, long-term outcomes continue to be suboptimal. Conversion to biventricular circulation is increasingly gaining popularity, particularly in the subset of patients who are not ideal Fontan candidates. Meticulous image-guided planning, extensive preoperative discussions, and a team-based approach are required for successful execution of complex biventricular conversion. A segmental approach to the anatomy of the heart defect allows methodical planning of the technique of biventricular conversion. Ventricular size and function continue to be the Achilles heel of successful biventricular repair. Long-term studies comparing outcomes in patients converted to biventricular circulation to those in patients with Fontan physiology are required to appropriately tailor management approaches to an individual patient.
尽管在患有单心室生理学的患者的 Fontan 循环管理方面取得了重大进展，但长期结果仍不理想。双心室循环的转换越来越受到欢迎，特别是在那些不适合 Fontan 手术的患者亚组中。成功实施复杂的双心室转换需要进行精心的图像引导规划、广泛的术前讨论和基于团队的方法。心脏缺陷解剖的节段性方法允许对双心室转换技术进行系统规划。心室大小和功能仍然是成功的双心室修复的致命弱点。需要进行长期研究，比较转换为双心室循环的患者和具有 Fontan 生理学的患者的结局，以便根据个体患者的情况适当调整管理方法。
