DeLeon S Y, Idriss F S, Ilbawi M N, Muster A J, Paul M H, Cole R B, Riggs T W, Berry T E
J Thorac Cardiovasc Surg. 1983 May;85(5):669-77.
Twenty-seven patients (3 to 22 years) underwent the Fontan operation. Seventeen had tricuspid atresia and 10 had other complex lesions. Sixteen patients had a Glenn shunt (12 prior to, three simultaneous with, and one following the Fontan operation). One early death (3.7%) occurred in a 4 1/2-year-old child with tricuspid atresia II-C, previous pulmonary artery banding, and a closing ventricular septal defect (80 mm Hg gradient). There were two late deaths (7.4%) from Candida sepsis, after 4 and 6 months, respectively. The 24 patients who survived the Fontan operation had postoperative hospital stays of 6 to 90 days (average 18). Patients with tricuspid atresia and an established Glenn shunt (nine patients, Group I) had postoperative hospital stays of 7 to 19 days (average 9.5), and none had significant pleural or pericardial effusions. Patients with tricuspid atresia without a Glenn shunt (seven patients, Group II) had postoperative hospital stays of 6 to 60 days (average 17.5), with three having significant effusions. Of the patients with other complex lesions, all without an established Glenn shunt, five had significant effusions. Four additional major complications (two tricuspid patch disruptions with ineffective pulmonary blood flow and two complete occlusions of a valved conduit) were encountered in which the Glenn shunt proved lifesaving. We believe that an established Glenn shunt played a major role in attaining minimal postoperative hemodynamic instability, effusions, renal failure, and mortality in our patients. The Glenn shunt should be considered in patients who are less than ideal candidates for the Fontan operation.
27例患者（年龄3至22岁）接受了Fontan手术。其中17例为三尖瓣闭锁，10例为其他复杂病变。16例患者进行了Glenn分流术（12例在Fontan手术前，3例与Fontan手术同时进行，1例在Fontan手术后）。1例早期死亡（3.7%）发生在一名4岁半患有II - C型三尖瓣闭锁、既往有肺动脉束带术且室间隔缺损有80 mmHg压差正在闭合的儿童。分别在术后4个月和6个月时，有2例因念珠菌败血症晚期死亡（7.4%）。接受Fontan手术存活的24例患者术后住院时间为6至90天（平均18天）。有已建立Glenn分流术的三尖瓣闭锁患者（9例，第一组）术后住院时间为7至19天（平均9.5天），且无一例有明显胸腔或心包积液。没有Glenn分流术的三尖瓣闭锁患者（7例，第二组）术后住院时间为6至60天（平均17.5天），3例有明显积液。在其他复杂病变患者中，均未建立Glenn分流术，5例有明显积液。还遇到了另外4例主要并发症（2例三尖瓣补片破裂导致肺血流量不足，2例带瓣管道完全闭塞），其中Glenn分流术被证明挽救了生命。我们认为，已建立的Glenn分流术在使我们的患者术后血流动力学不稳定、积液、肾衰竭和死亡率降至最低方面发挥了重要作用。对于Fontan手术不太理想的患者，应考虑行Glenn分流术。
