Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.
Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany.
Interact Cardiovasc Thorac Surg. 2022 Jul 9;35(2). doi: 10.1093/icvts/ivac190.
Clinical significance of aortopulmonary collaterals (APCs) in patients with univentricular heart remains controversial. This study aimed to evaluate the incidence and associated factors for APCs and their influence during staged palliation.
In total, 430 patients who underwent staged palliation by bidirectional Glenn shunt and total cavopulmonary connection between 2003 and 2019 were examined. APCs were determined by angiogram. Incidence and interventions for APCs were analysed.
The most frequent diagnosis was hypoplastic left heart syndrome in 146 (34%) patients. The median age at Glenn and Fontan was 4.9 months and 2.1 years, respectively. APCs were observed in 54 (13%) patients at Glenn and in 179 (42%) at Fontan. Closure of APCs was performed before Glenn in 12 (3%) patients, at Glenn in 13 (3%), after Glenn in 8 (2%), before Fontan in 44 (10%), at Fontan in 26 (6%) and after Fontan in 52 (12%). Hypoplastic left heart syndrome (P < 0.01) was highly associated with the development of APCs before Glenn. Lower Nakata-Index and younger age at Glenn shunt were associated with the development of APCs at Fontan procedure. The presence of APCs or intervention for APCs before total cavopulmonary connection did not influence intensive care unit stay or mortality after total cavopulmonary connection.
APCs were most frequently observed before Fontan procedure. Hypoplastic left heart syndrome was highly associated with the development of APCs before Glenn shunt. Lower Nakata-Index and younger age at Glenn shunt were associated with APCs before Fontan procedure.
主-肺动脉侧支（APCs）在单心室心脏患者中的临床意义仍存在争议。本研究旨在评估 APCs 的发生率及相关因素及其在分期姑息治疗中的影响。
共对 2003 年至 2019 年期间接受双向 Glenn 分流术和全腔静脉肺动脉连接分期姑息治疗的 430 例患者进行了检查。通过血管造影确定 APCs 的存在。分析 APCs 的发生率和干预措施。
最常见的诊断是左心发育不全综合征 146 例（34%）。Glenn 和 Fontan 时的中位年龄分别为 4.9 个月和 2.1 岁。Glenn 时观察到 54 例（13%）患者和 Fontan 时观察到 179 例（42%）患者存在 APCs。Glenn 前有 12 例（3%）、Glenn 时 13 例（3%）、Glenn 后 8 例（2%）、Fontan 前 44 例（10%）、Fontan 时 26 例（6%）和 Fontan 后 52 例（12%）患者行 APCs 闭合术。Glenn 前左心发育不全综合征（P<0.01）与 APCs 的发生高度相关。较低的 Nakata 指数和 Glenn 分流术时的年龄与 Fontan 手术时 APCs 的发生相关。全腔静脉肺动脉连接前存在 APCs 或对 APCs 进行干预并不影响全腔静脉肺动脉连接后的重症监护病房停留时间或死亡率。
APCs 最常发生在 Fontan 手术前。左心发育不全综合征与 Glenn 分流术前 APCs 的发生高度相关。较低的 Nakata 指数和 Glenn 分流术时的年龄与 Fontan 手术前 APCs 的发生相关。
