Mayer J E, Helgason H, Jonas R A, Lang P, Vargas F J, Cook N, Castaneda A R
J Thorac Cardiovasc Surg. 1986 Dec;92(6):1021-8.
During the early development of atriopulmonary anastomotic operations (Fontan-Kreutzer), a number of physiologic and anatomical limits were proposed by the Fontan group as selection criteria. Among 167 consecutive patients undergoing modified Fontan procedures from 1973 through 1985, 109 (65%) patients exceeded one or more of the original selection criteria in areas of age, anomalies of systemic or pulmonary venous connection, pulmonary artery distortion, and pulmonary artery pressure. Twenty-six patients had a mean pulmonary artery pressure greater than 15 mm Hg, with 16 operative survivors (62%). Nineteen patients had anomalies of systemic and/or pulmonary venous connection, and 16 survived (84%). There were 44 patients under the age of 4 years, and 26 survived (59%). Twenty-five patients were older than 15 years, and 23 (92%) survived the Fontan procedure. Pulmonary artery distortion, relating to prior palliative operations, was found in 34 patients. Seventeen of these 34 survived a modified Fontan procedure (50%). Twenty-six patients had a pulmonary arteriolar resistance more than 2 Wood units times square meter, and 14 survived (54%), whereas 81 of 93 with a pulmonary arteriolar resistance of less than 2 U X m2 survived (87%). Multivariate analysis showed that pulmonary arteriolar resistance and pulmonary artery distortion had a significant, negative impact on survival, but age and anomalies of systemic and/or pulmonary venous connection did not. Pulmonary artery pressure was not an independent predictor of outcome. The results show that the original criteria may be exceeded in the areas of age and anomalies of pulmonary or systemic venous connection. Pulmonary artery pressure alone should not contraindicate a Fontan procedure if pulmonary arteriolar resistance is low. Pulmonary artery distortion from a prior palliative operation and elevated pulmonary arteriolar resistance increase the risk of a Fontan procedure.
在心房-肺动脉吻合术（Fontan-Kreutzer术）的早期发展阶段，Fontan团队提出了一些生理和解剖学限制作为选择标准。在1973年至1985年间连续接受改良Fontan手术的167例患者中，109例（65%）患者在年龄、体循环或肺静脉连接异常、肺动脉扭曲和肺动脉压力等方面超出了一项或多项原始选择标准。26例患者的平均肺动脉压大于15 mmHg，其中16例手术存活（62%）。19例患者存在体循环和/或肺静脉连接异常，16例存活（84%）。44例患者年龄在4岁以下及其中26例存活（59%）。25例患者年龄超过15岁，23例（92%）在Fontan手术后存活。34例患者发现有与既往姑息手术相关的肺动脉扭曲。这34例患者中有17例在改良Fontan手术后存活（50%）。26例患者的肺小动脉阻力超过2伍德单位×平方米，14例存活（54%），而93例肺小动脉阻力小于2 U×m2的患者中有81例存活（87%）。多因素分析显示，肺小动脉阻力和肺动脉扭曲对生存率有显著的负面影响，但年龄以及体循环和/或肺静脉连接异常则无此影响。肺动脉压力并非结局的独立预测因素。结果表明，在年龄以及肺或体循环静脉连接异常方面可能超出原始标准。如果肺小动脉阻力较低，仅肺动脉压力不应成为Fontan手术的禁忌证。既往姑息手术导致的肺动脉扭曲和升高的肺小动脉阻力会增加Fontan手术的风险。
