Bridges N D, Lock J E, Mayer J E, Burnett J, Castaneda A R
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
J Am Coll Cardiol. 1995 Jun;25(7):1712-7. doi: 10.1016/0735-1097(95)00055-9.
Our objective was to determine whether catheterization data obtained after a fenestrated Fontan operation influenced patient management or predicted functional status.
Cardiac catheterization after a fenestrated Fontan operation is undertaken to identify residual lesions and to observe the patient's response to test occlusion of the baffle fenestration.
Sixty patients undergoing both a fenestrated Fontan operation before July 1991 and a postoperative catheterization before March 1992 were included in the study. Catheterization data were collected according to a test occlusion protocol; these data were reviewed, and the patient's clinical status at follow-up was ascertained.
Test occlusion resulted in a significant increase in systemic venous pressure, arterial oxygen saturation and arteriovenous difference in oxygen content (p < 0.0001). After test occlusion, systemic venous pressure was 40% higher and systemic venous saturation 23% lower among patients with an unfavorable versus a favorable response to test occlusion, although differences between the two groups were subtle or inapparent in the baseline state. Branch pulmonary artery stenosis (identified and balloon dilated in 6 patients) and grade 2 or 3 aortopulmonary collateral vessels (identified and coil embolized in 20) were associated with elevation in systemic venous pressure (p < 0.01). After an average of 2 years of follow-up, there were no deaths, and 50 (83%) of 60 patients were in New York Heart Association functional class I. The only postoperative characteristic significantly associated with being in functional class I at follow-up was a systemic venous pressure < 17 mm Hg.
Cardiac catheterization with test occlusion of the interatrial communication provides useful information after a fenestrated Fontan operation. Conditions associated with elevated systemic venous pressure should be sought and treated, and the response of systemic venous pressure to test occlusion should be considered when deciding whether to close an interatrial communication.
我们的目的是确定在开窗Fontan手术之后获得的导管插入术数据是否会影响患者的管理或预测功能状态。
开窗Fontan手术后进行心脏导管插入术是为了识别残留病变，并观察患者对挡板开窗试验性封堵的反应。
纳入60例在1991年7月前接受开窗Fontan手术且在1992年3月前接受术后导管插入术的患者。根据试验性封堵方案收集导管插入术数据；对这些数据进行回顾，并确定患者随访时的临床状态。
试验性封堵导致体循环静脉压、动脉血氧饱和度和动静脉氧含量差显著增加（p<0.0001）。试验性封堵后，对试验性封堵反应不佳的患者与反应良好的患者相比，体循环静脉压高40%，体循环静脉血氧饱和度低23%，尽管两组在基线状态下的差异细微或不明显。分支肺动脉狭窄（6例患者被识别并进行球囊扩张）和2级或3级主肺动脉侧支血管（20例患者被识别并进行弹簧圈栓塞）与体循环静脉压升高相关（p<0.01）。平均随访2年后，无死亡病例，60例患者中有50例（83%）处于纽约心脏协会心功能I级。随访时与处于心功能I级显著相关的唯一术后特征是体循环静脉压<17mmHg。
心房交通试验性封堵的心脏导管插入术在开窗Fontan手术后提供了有用的信息。应寻找并治疗与体循环静脉压升高相关的情况，并且在决定是否关闭心房交通时应考虑体循环静脉压对试验性封堵的反应。
