Uemura H, Yagihara T, Kawashima Y, Okada K, Kamiya T, Anderson R H
National Cardiovascular Center, Osaka, Japan.
Circulation. 1995 Nov 1;92(9 Suppl):II228-32. doi: 10.1161/01.cir.92.9.228.
Relative regression of the pulmonary arterial size has been reported after a conventional bidirectional Glenn procedure. Maintaining a supplemental pulmonary flow could be of surgical value unless the option also militates against the efficacy of the partial right heart bypass.
Twenty-seven patients considered unsuitable for a Fontan-type procedure underwent a bidirectional Glenn procedure in the presence of forward flow from the ventricles to the pulmonary arteries, the flow being maintained through the pulmonary trunk in 22 or a systemic-to-pulmonary shunt in 5. There was one surgical death due to atrioventricular valvular regurgitation. Subsequently, 9 patients have successfully undergone a total cavopulmonary connection 2.6 +/- 1.9 years after the initial procedure. Preoperative and postoperative catheterizations revealed changes in arterial oxygen saturation (75 +/- 11% compared with 83 +/- 7%, P < .001) and end-diastolic volumes of the systemic ventricles (from 238 +/- 92% to 188 +/- 97% of the expected normal volume, P < .01), whereas no difference was detected in the mean cross-sectional area of the right and left pulmonary arteries compared with the expected normal value for the right pulmonary artery (from 76 +/- 21% to 81 +/- 20%) or in the ventricular ejection fraction (from 53 +/- 8% to 50 +/- 14%). The relative regression or growth of the pulmonary arterial size was statistically related to the size of the channel for forward flow.
Maintenance of forward flow from the ventricle provides a feasible means, when performing a bidirectional Glenn procedure, of protecting against regression of pulmonary arterial size as well as off-loading the ventricles and improving arterial oxygen saturation.
据报道，在传统双向格林手术之后，肺动脉大小会出现相对缩小。维持额外的肺血流可能具有手术价值，除非这种选择也会对部分右心旁路的疗效产生不利影响。
27例被认为不适合进行Fontan类手术的患者在存在从心室到肺动脉的前向血流的情况下接受了双向格林手术，其中22例通过肺动脉干维持血流，5例通过体肺分流维持血流。有1例因房室瓣反流导致手术死亡。随后，9例患者在初次手术后2.6±1.9年成功接受了全腔静脉肺动脉连接术。术前和术后的心导管检查显示动脉血氧饱和度发生了变化（分别为75±11%和83±7%，P<.001），以及体心室舒张末期容积发生了变化（从预期正常容积的238±92%降至188±97%，P<.01），而与右肺动脉预期正常值相比，左右肺动脉的平均横截面积无差异（从76±21%变为81±20%），心室射血分数也无差异（从53±8%变为50±14%）。肺动脉大小的相对缩小或增大与前向血流通道的大小在统计学上相关。
在进行双向格林手术时，维持心室的前向血流是一种可行的方法，既能防止肺动脉大小缩小，又能减轻心室负荷并提高动脉血氧饱和度。
