Azhar Ahmad, Eid Rehan, Elakaby Ahmed, Abdelsalam Mohamed, Al-Ata Jameel, Alkhushi Naif, Bahaidarah Saud, Zaher Zaher, Maghrabi Khadijah, Noaman Nada, Abdelmohsen Gaser
Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O Box 80215, Jeddah, 21589, Saudi Arabia.
Paediatric Department, Al-Azhar University, Cairo, Egypt.
Egypt Heart J. 2022 Aug 4;74(1):57. doi: 10.1186/s43044-022-00296-4.
Cardiac catheterization is usually done routinely in patients with univentricular hearts before palliative Bidirectional Glenn (BDG) surgery. The objective of this study was to compare the outcomes of patients with physiological univentricular hearts and restrictive pulmonary flow that did not undergo routine cardiac catheterization before BDG with the patients that did have cardiac catheterization done. We retrospectively reviewed the data of all patients with single ventricle physiology and restrictive pulmonary blood flow who underwent BDG surgery from January 2016 till December 2020. Patients were divided into two groups: the catheterization and the non-catheterization groups.
Out of 93 patients, 25 (27%) underwent BDG surgery without prior cardiac catheterization. The median age of patients was ten months, interquartile range (IQR) was 5-18 months. Tricuspid atresia represented 36% of the non-catheterization group, while unbalanced atrioventricular septal defect and hypoplastic left heart syndrome represented 19% and 17.6% of the catheterization group. No patients in the catheterization group were excluded from further BDG surgery based on the catheterization data. Moreover, no significant differences were found between the patients' groups regarding the length of hospital stay, length of intensive care unit stay, postoperative oxygen saturation, or survival (P = 0.266, P = 0.763, P = 0.543, P = 0456).
Although pre-BDG cardiac catheterization is the routine and standard practice, in certain situations, some patients with single ventricle physiology and restrictive pulmonary blood flow may go directly to BDG without cardiac catheterization if noninvasive imaging is satisfactory on a case-by-case basis and according to center experience. Pre-BDG catheterization could be reserved for patients with limited echocardiographic studies, high-risk patients, or those indicated for catheter intervention before BDG surgery.
对于单心室心脏患者，在进行姑息性双向格林（BDG）手术前通常会常规进行心导管检查。本研究的目的是比较在BDG手术前未进行常规心导管检查的生理性单心室心脏且肺血流受限的患者与进行了心导管检查的患者的结局。我们回顾性分析了2016年1月至2020年12月期间所有接受BDG手术的单心室生理且肺血流受限患者的数据。患者分为两组：心导管检查组和非心导管检查组。
93例患者中，25例（27%）在未进行心导管检查的情况下接受了BDG手术。患者的中位年龄为10个月，四分位间距（IQR）为5 - 18个月。三尖瓣闭锁占非心导管检查组的36%，而房室间隔缺损不平衡和左心发育不全综合征分别占心导管检查组的19%和17.6%。心导管检查组中没有患者因心导管检查数据而被排除在进一步的BDG手术之外。此外，在住院时间、重症监护病房住院时间、术后血氧饱和度或生存率方面，两组患者之间没有发现显著差异（P = 0.266，P = 0.763，P = 0.543，P = 0.456）。
尽管BDG手术前的心导管检查是常规和标准做法，但在某些情况下，如果逐案的无创成像结果令人满意且根据中心经验，一些单心室生理且肺血流受限的患者在不进行心导管检查的情况下可直接进行BDG手术。BDG手术前的心导管检查可保留给超声心动图检查有限的患者、高危患者或那些在BDG手术前需要进行导管介入的患者。
