Department of Cardiac Surgery, Polish Mother's Memorial Hospital - Research Institute, Rzgowska 281/289, Lodz, 93-338, Poland.
Department of Cardiac Surgery, Helios Hospital, Lutherplatz 40, Krefeld, 47805, Germany.
BMC Pediatr. 2024 Nov 6;24(1):705. doi: 10.1186/s12887-024-05183-2.
The benefit of additional pulmonary blood flow (APBF) in Fontan pathway remains controversial. The aim of the study was to analyze the systemic arterial saturation, ventricular and atrioventricular (AV) valve function, development of pulmonary arteries and postoperative course after Fontan operation in children with preserved or eliminated APBF between stages 2 and 3 of the Fontan pathway.
A group of 180 consecutive children (median age: 2.92(1.83-16.83) years) with single ventricle underwent extracardiac conduit Fontan operation. The patients were retrospectively analyzed with respect to the presence of APBF between stages 2 and 3.
Preoperative echocardiography showed no differences in ventricular function (good - 105[95%] vs. 65[98.5%]; reduced - 9[5%] vs 1[1.5%]; p = 0.07) or AV valve function (p = 0.78). There was no difference in oxygen saturation at admission (p = 0.48), in preoperative blood gas analysis (p = 0.62), or at the discharge (p = 0.73). There was no difference in size of the left pulmonary artery (9.5(0-16.2) vs 10.6 (4.9-21.7) mm; p = 0.13), however the right pulmonary artery was significantly larger (11.2(6.5-19.6) vs. 12.8(7.8-2.5) mm; p = 0.048) in APBF group. In this group the mean pressure in the pulmonary artery was significantly higher as well (8[4-17.5] vs 9.5[4-17.3] mmHg; p = 0.03).
APBF does not result in higher oxygen saturation, both before and after Fontan completion. APBF can stimulate the growth of the pulmonary arteries and increase the pulmonary artery pressure. The presence of APBF does not affect the post-operative course after Fontan operation, however it can increase the need of AV valve reconstruction.
在 Fontan 通路中增加肺血流量（APBF）的益处仍存在争议。本研究旨在分析 2 至 3 期 Fontan 通路中保留或消除 APBF 的儿童的全身动脉饱和度、心室和房室（AV）瓣膜功能、肺动脉发育以及 Fontan 手术后的病程。
一组 180 例连续接受体外循环管道 Fontan 手术的单心室儿童（中位年龄：2.92(1.83-16.83)岁）。回顾性分析了 2 至 3 期之间存在 APBF 的患者。
术前超声心动图显示心室功能（良好-105[95%] vs. 65[98.5%]；减少-9[5%] vs. 1[1.5%]；p=0.07）或 AV 瓣膜功能（p=0.78）无差异。入院时氧饱和度无差异（p=0.48），术前血气分析无差异（p=0.62），出院时也无差异（p=0.73）。左肺动脉大小无差异（9.5(0-16.2) vs 10.6 (4.9-21.7) mm；p=0.13），但 APBF 组右肺动脉明显更大（11.2(6.5-19.6) vs. 12.8(7.8-2.5) mm；p=0.048）。该组肺动脉平均压力也明显较高（8[4-17.5] vs 9.5[4-17.3] mmHg；p=0.03）。
APBF 不会导致 Fontan 完成前后的氧饱和度升高。APBF 可刺激肺动脉生长并增加肺动脉压力。APBF 的存在并不影响 Fontan 手术后的病程，但会增加 AV 瓣膜重建的需要。
