Hofbeck M, Singer H, Scharf J, Rupprecht T, Ries M, Buheitel G, Blum U, Mahmoud O, Emde J V
Klinik mit Poliklinik für Kinder und Jugendliche der Universität Erlangen-Nürnberg.
Z Kardiol. 1994 Sep;83(9):615-22.
In recent years, an increasing number of modified Fontan-operations has been performed in children younger than 4 years of age. The purpose of this study was to identify preoperative risk factors in this age group. From February 1990 until February 1993, we performed in our center a modified Fontan-operation using the technique of total cavopulmonary anastomosis (TCPA) in 37 consecutive patients (17 pts. < 4 years = group I, 20 pts. > 4 years = group II). Early postoperative mortality occurred in patients of group I only (n = 3 pts.). All of these patients had additional preoperative risk factors. Pulmonary vascular resistance (PVRI) > 2 U x m2 was a significant risk factor for the younger patients while pulmonary artery size alone (expressed as the McGoon-ratio or Nakata-index) could not be identified as a separate risk factor. Using two additional indices (McGoon-ratio/PVRI and Nakata-index/PVRI), we were able to identify patients with unfavorable postoperative hemodynamics as high-risk patients. In our experience, TCPA can be performed in patients younger than 4 years of age with a low mortality, if there are no additional preoperative risk factors. For high-risk patients we recommend either a bidirectional Glenn-anastomosis as a first step procedure or a TCPA with fenestration of the intraatrial tunnel-patch.
近年来，越来越多4岁以下儿童接受了改良Fontan手术。本研究的目的是确定该年龄组的术前危险因素。从1990年2月至1993年2月，我们中心对37例连续患者（17例＜4岁 = 第一组，20例＞4岁 = 第二组）采用全腔肺吻合术（TCPA）技术进行了改良Fontan手术。仅第一组患者发生了术后早期死亡（n = 3例）。所有这些患者都有额外的术前危险因素。肺血管阻力（PVRI）＞2 U×m²是较年轻患者的一个显著危险因素，而单独的肺动脉大小（以McGoon比值或Nakata指数表示）不能被确定为一个独立的危险因素。使用另外两个指标（McGoon比值/PVRI和Nakata指数/PVRI），我们能够将术后血流动力学不良的患者识别为高危患者。根据我们的经验，如果没有额外的术前危险因素，4岁以下患者可以进行TCPA，死亡率较低。对于高危患者，我们建议要么首先进行双向Glenn吻合术，要么进行带房间隔隧道补片开窗的TCPA术。
