Miyaji K, Shimada M, Sekiguchi A, Ishizawa A, Isoda T
Department of Cardiovascular Surgery, National Chidren's Hospital, Tokyo, Japan.
Ann Thorac Surg. 1996 Mar;61(3):845-50. doi: 10.1016/0003-4975(95)01121-8.
A bidirectional cavopulmonary shunt has been performed for the high-risk Fontan patient. It is well known that in the presence of the bidirectional cavopulmonary shunt alone to secure pulmonary blood flow, the central pulmonary artery size decreases over time. We have performed pulsatile bidirectional cavopulmonary shunt (PBCPS), keeping pulmonary blood flow from the ventricle through the stenotic pulmonary valve, or a Blalock-Taussig shunt in patients who do not meet the criteria for the Fontan operation.
Eleven patients who underwent PBCPS between 1989 and 1993 were reviewed. We compared the results of cardiac catheterization immediately before PBCPS and during the postoperative observation period (310 +/- 257 days).
Pulmonary blood flow and arterial oxygen saturation increased significantly after PBCPS (p = 0.01). Pulmonary artery area index showed a tendency to increase (p = 0.11). The mean number of risk factors for the Fontan procedure decreased significantly for 1.8 +/- 1.1 to 0.7 +/- 0.8 after PBCPS (p < 0.05). Overall, 5 of the 11 patients (45.5%) met the criteria for the Fontan procedure, and a fenestrated Fontan procedure was carried out in 4 of them.
The PBCPS is useful for high-risk Fontan patients not only in the staged Fontan operation, but also as definitive palliation.
已为高危的Fontan患者实施双向腔肺分流术。众所周知，仅在存在双向腔肺分流以确保肺血流的情况下，中央肺动脉大小会随时间减小。我们已对不符合Fontan手术标准的患者实施了搏动性双向腔肺分流术（PBCPS），通过狭窄的肺动脉瓣维持来自心室的肺血流，或实施Blalock-Taussig分流术。
回顾了1989年至1993年间接受PBCPS的11例患者。我们比较了PBCPS术前即刻和术后观察期（310±257天）的心脏导管检查结果。
PBCPS术后肺血流和动脉血氧饱和度显著增加（p = 0.01）。肺动脉面积指数有增加趋势（p = 0.11）。Fontan手术的平均危险因素数量在PBCPS术后从1.8±1.1显著降至0.7±0.8（p < 0.05）。总体而言，11例患者中有5例（45.5%）符合Fontan手术标准，其中4例实施了开窗Fontan手术。
PBCPS不仅在分期Fontan手术中，而且作为确定性姑息治疗，对高危Fontan患者均有用。
