Senzaki H, Isoda T, Ishizawa A, Hishi T
Department of Pediatric Cardiology, National Children's Hospital, Tokyo, Japan.
Circulation. 1994 Mar;89(3):1196-202. doi: 10.1161/01.cir.89.3.1196.
The outcome of the Fontan operation largely depends on the selection of patients because this procedure is a physiological correction. Among the several selection criteria for the Fontan operation, the importance of adequate size of the pulmonary artery remains controversial. In this series, in order to clarify whether the pulmonary artery size is indispensable or not as one of the selection criteria for the Fontan operation, we considered the physiological meaning of pulmonary artery size and investigated how it influenced postoperative hemodynamics of the Fontan operation.
In congenital heart disease of decreasing pulmonary blood flow, 40 patients were examined for this analysis. Pulmonary artery indexes (cross-sectional area of the right and left pulmonary arteries divided by body surface area) were measured as the expression of pulmonary artery size, and the relations of pulmonary artery index (PAI) to pulmonary vascular resistance (Rp) and compliance (Cp) were studied. There was no significant correlation between PAI and Rp, whereas a significant correlation was found between PAI and Cp (r = .71, P = .001). Furthermore, Cp influenced postoperative hemodynamics of the Fontan operation by affecting the peak central venous pressure (pCVP) and total impedance, which was the afterload to the ventricle. Impedance increased abruptly when PAI was < approximately 100 mm2/m2.
The smaller pulmonary artery size causes more disadvantageous hemodynamics after the Fontan operation, with resultant effects of the rise in pCVP and the increase in afterload to the single ventricle.
由于Fontan手术是一种生理性矫正手术，其手术效果在很大程度上取决于患者的选择。在Fontan手术的多种选择标准中，肺动脉大小是否合适的重要性仍存在争议。在本系列研究中，为了阐明肺动脉大小作为Fontan手术选择标准之一是否必不可少，我们探讨了肺动脉大小的生理意义，并研究了其对Fontan手术后血流动力学的影响。
对40例肺血流量减少的先天性心脏病患者进行了此项分析。测量肺动脉指数（左右肺动脉横截面积除以体表面积）以表示肺动脉大小，并研究肺动脉指数（PAI）与肺血管阻力（Rp）和顺应性（Cp）之间的关系。PAI与Rp之间无显著相关性，而PAI与Cp之间存在显著相关性（r = 0.71，P = 0.001）。此外，Cp通过影响中心静脉压峰值（pCVP）和总阻抗（即心室的后负荷）来影响Fontan手术后的血流动力学。当PAI < 约100 mm²/m²时，阻抗会突然增加。
较小的肺动脉大小会导致Fontan手术后血流动力学更不利，从而导致pCVP升高和单心室后负荷增加。
