Demir Ibrahim Halil, Celebi Ahmet, Ozdemir Dursun Muhammed, Yilmaz Emine Hekim, Bulut Mustafa Orhan, Surucu Murat, Korun Oktay, Aydemir Numan Ali, Yucel Ilker Kemal
Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street, No: 13 Uskudar, Istanbul, Turkey.
Department of Pediatric Cardiovascular Surgery, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Pediatr Cardiol. 2024 Mar;45(3):632-639. doi: 10.1007/s00246-023-03380-x. Epub 2024 Jan 5.
In individuals with a single ventricle undergoing evaluation before Fontan surgery, the presence of excessive pulmonary blood flow can contribute to increased pulmonary artery pressure, notably in those who had a Glenn procedure with antegrade pulmonary flow. 28 patients who had previously undergone Glenn anastomosis with antegrade pulmonary blood flow (APBF) and with elevated mean pulmonary artery (mPAP) pressure > 15 mmHg in diagnostic catheter angiography were included in the study. After addressing other anatomical factors that could affect pulmonary artery pressure, APBF was occluded with semi-compliant, Wedge or sizing balloons to measure pulmonary artery pressure accurately. 23 patients (82% of the cohort) advanced to Fontan completion. In this group, median mPAP dropped from 20.5 (IQR 19-22) mmHg to 13 (IQR 12-14) mmHg post-test (p < 0.001). Median PVR post-test was 1.8 (IQR 1.5-2.1) WU m. SpO2 levels decreased from a median of 88% (IQR 86%-93%) pre-test to 80% (IQR 75%-84%) post-test (p < 0.001). In five patients, elevated mPAP post-test occlusion on diagnostic catheter angiography led to non-completion of Fontan circulation. In this group, median pre- and post-test mPAP were 23 mmHg (IQR 21.5-23.5) and 19 mmHg (IQR 18.5-20), respectively (p = 0.038). Median post-test PVR was 3.8 (IQR 3.6-4.5) WU m. SpO2 levels decreased from a median of 79% (IQR 76%-81%) pre-test to 77% (IQR 73.5%-80%) post-test (p = 0.039). Our study presents a specialized approach for patients initially deemed unsuitable for Fontan due to elevated pulmonary artery pressures. We were able to successfully complete the Fontan procedure in the majority of these high-risk cases after temporary balloon occlusion test.
在接受Fontan手术前评估的单心室患者中，肺血流量过多会导致肺动脉压力升高，尤其是那些接受了Glenn手术且有顺行肺血流的患者。本研究纳入了28例此前接受过Glenn吻合术且有顺行肺血流（APBF）、诊断性心导管血管造影显示平均肺动脉（mPAP）压力>15 mmHg的患者。在解决了其他可能影响肺动脉压力的解剖因素后，使用半顺应性球囊、楔形球囊或 sizing 球囊阻断APBF，以准确测量肺动脉压力。23例患者（占队列的82%）完成了Fontan手术。在这组患者中，测试后mPAP的中位数从20.5（四分位间距19 - 22）mmHg降至13（四分位间距12 - 14）mmHg（p < 0.001）。测试后肺血管阻力（PVR）的中位数为1.8（四分位间距1.5 - 2.1）WU m。血氧饱和度（SpO2）水平从测试前的中位数88%（四分位间距86% - 93%）降至测试后的80%（四分位间距75% - 84%）（p < 0.001）。5例患者在诊断性心导管血管造影测试后阻断时mPAP升高，导致Fontan循环未完成。在这组患者中，测试前和测试后mPAP的中位数分别为23 mmHg（四分位间距21.5 - 23.5）和19 mmHg（四分位间距18.5 - 20）（p = 0.038）。测试后PVR的中位数为3.8（四分位间距3.6 - 4.5）WU m。SpO2水平从测试前的中位数79%（四分位间距76% - 81%）降至测试后的77%（四分位间距73.5% - 80%）（p = 0.039）。我们的研究为最初因肺动脉压力升高而被认为不适合Fontan手术的患者提供了一种专门的方法。在进行临时球囊阻断测试后，我们能够在大多数这些高风险病例中成功完成Fontan手术。
