格林分流术与Fontan手术之间的体静脉侧支循环：发生率、治疗及对预后的影响。

Systemic venous collaterals between Glenn and Fontan: prevalence, therapy, and impact on outcomes.

作者信息

Nguyen Cong Michelle Bao Hoa, Schaeffer Thibault, Osawa Takuya, Palm Jonas, Niedermaier Carolin, Piber Nicole, Matsubara Muneaki, Heinisch Paul Philipp, Georgiev Stanimir, Hager Alfred, Ewert Peter, Hörer Jürgen, Ono Masamichi

机构信息

Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Europäisches Kinderherzzentrum München, Munich, Germany.

Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany.

出版信息

Cardiol Young. 2025 Jan 30:1-8. doi: 10.1017/S104795112403662X.

DOI:10.1017/S104795112403662X

PMID:39882628

Abstract

OBJECTIVE

This study aimed to evaluate veno-venous collaterals between bidirectional cavopulmonary shunt and total cavopulmonary connection.

METHODS

Patients who underwent staged total cavopulmonary connection between 1995 and 2022 were reviewed. Veno-venous collaterals between bidirectional cavopulmonary shunt and total cavopulmonary connection were depicted using angiograms. The prevalence of veno-venous collaterals, the risks for the development of veno-venous collaterals, and the impact of veno-venous collaterals on outcomes were analysed.

RESULTS

In total, 586 patients were included. Veno-venous collaterals were found in 72 (12.3%) patients. Majority of veno-venous collaterals originated from the superior caval vein and drained into the inferior caval vein. Before bidirectional cavopulmonary shunt, mean pulmonary artery pressure (16.3 vs. 14.5 mmHg, = 0.018), and trans-pulmonary gradient (9.5 vs. 8.0 mmHg, = 0.030) were higher in patients with veno-venous collaterals compared to those without. Veno-venous collaterals intervention was performed in 32 (5.5%) patients, in a median of 29 (16-152) days after bidirectional cavopulmonary shunt. Before total cavopulmonary connection, pulmonary artery pressure (10.3 vs. 9.4 mmHg, = 0.015) and ventricular end-diastolic pressure (8.4 vs. 7.6 mmHg, = 0.035) were higher, and arterial oxygen saturation (SaO, 80.6 vs. 82.6 %, = 0.018) was lower in patients with veno-venous collaterals compared to those without. More palliations before total cavopulmonary connection ( < 0.001, odds ratio: 1.689) were an independent risk for the development of veno-venous collaterals. Veno-venous collaterals did not affect survival after total cavopulmonary connection (92.8 vs. 92.7% at 10 years, = 0.600).

CONCLUSIONS

The prevalence of veno-venous collaterals between bidirectional cavopulmonary shunt and total cavopulmonary connection was 12%. Veno-venous collaterals may be induced by the elevated pulmonary artery pressure and trans-pulmonary gradient, and also by more previous palliations. However, they had no impact on clinical outcomes following total cavopulmonary connection.

摘要

目的

本研究旨在评估双向腔肺分流与全腔肺连接之间的静脉-静脉侧支循环。

方法

回顾1995年至2022年间接受分期全腔肺连接的患者。使用血管造影描绘双向腔肺分流与全腔肺连接之间的静脉-静脉侧支循环。分析静脉-静脉侧支循环的发生率、静脉-静脉侧支循环形成的风险以及静脉-静脉侧支循环对预后的影响。

结果

共纳入586例患者。72例（12.3%）患者发现有静脉-静脉侧支循环。大多数静脉-静脉侧支循环起源于上腔静脉，引流至下腔静脉。在双向腔肺分流前，有静脉-静脉侧支循环的患者平均肺动脉压（16.3 vs. 14.5 mmHg，P = 0.018）和跨肺压差（9.5 vs. 8.0 mmHg，P = 0.030）高于无静脉-静脉侧支循环的患者。32例（5.5%）患者在双向腔肺分流后中位29（16 - 152）天进行了静脉-静脉侧支循环干预。在全腔肺连接前，有静脉-静脉侧支循环的患者肺动脉压（10.3 vs. 9.4 mmHg，P = 0.015）和心室舒张末期压力（8.4 vs. 7.6 mmHg，P = 0.035）较高，动脉血氧饱和度（SaO₂，80.6 vs. 82.6%，P = 0.018）较低。全腔肺连接前更多的姑息治疗（P < 0.001，比值比：1.689）是静脉-静脉侧支循环形成的独立危险因素。静脉-静脉侧支循环不影响全腔肺连接后的生存率（10年时分别为92.8%和92.7%，P = 0.600）。