Slavik Z, Lamb R K, Webber S A, Devlin A M, Keeton B R, Monro J L, Salmon A P
Wessex Cardiothoracic Centre, Southampton General Hospital.
Heart. 1996 Jan;75(1):78-82. doi: 10.1136/hrt.75.1.78.
To define the lowest age at which the bidirectional superior cavopulmonary anastomosis can safely be used in infants with complex congenital heart defects.
A retrospective analysis of clinical, echocardiographic, haemodynamic, and angiographic data in four consecutive patients undergoing bidirectional superior cavopulmonary anastomosis below the age of 2 months.
Between November 1990 and September 1993, four infants less than 8 weeks of age (3, 4, 6, and 7 weeks) underwent bidirectional superior cavopulmonary anastomosis as a primary palliation for complex heart disease. The indication for early surgical intervention was progression of cyanosis (n = 3) and high pulmonary blood flow causing heart failure (n = 1). In two infants with tricuspid atresia, surgery was performed through a right thoracotomy without the use of cardiopulmonary bypass. In one infant with double inlet left ventricle and discordant ventriculoarterial connection, cavopulmonary anastomosis was combined with an arterial switch procedure. The final infant had double inlet left ventricle with pulmonary atresia; the central pulmonary arteries were virtually discontinuous and each branch was supplied by a separate arterial duct. The central pulmonary arteries were reconstructed using the subaortic innominate vein. Temporary prostacyclin infusion was used in three patients in the immediate postoperative period.
Early postoperative extubation (5, 7, and 48 h) was successful in three patients. The youngest child required ligation of the ductus arteriosus four days later because of severe upper body oedema. The postoperative course was complicated by prolonged effusions in two patients. All were alive and well 14-48 months postoperatively, with satisfactory systemic saturations (80-87%) and haemodynamic indices.
This limited experience challenges the widely held belief that the bidirectional superior cavopulmonary anastomosis cannot be used as a primary palliation for complex heart disease in early infancy. A wider experience is required to determine the safety and indications for this approach.
确定在患有复杂先天性心脏病的婴儿中安全使用双向腔肺吻合术的最低年龄。
对4例2个月以下接受双向腔肺吻合术的连续患者的临床、超声心动图、血流动力学和血管造影数据进行回顾性分析。
1990年11月至1993年9月期间，4例年龄小于8周（3、4、6和7周）的婴儿接受了双向腔肺吻合术，作为复杂心脏病的一期姑息治疗。早期手术干预的指征为紫绀进展（n = 3）和高肺血流量导致心力衰竭（n = 1）。2例三尖瓣闭锁婴儿通过右胸切口进行手术，未使用体外循环。1例双入口左心室且心室动脉连接不一致的婴儿，腔肺吻合术与动脉调转术联合进行。最后1例婴儿为双入口左心室合并肺动脉闭锁；中央肺动脉实际上是不连续的，每个分支由一条单独的动脉导管供血。使用主动脉下无名静脉重建中央肺动脉。3例患者术后即刻短期输注前列环素。
3例患者术后早期成功拔管（分别在5、7和48小时）。最年幼的患儿4天后因严重上身水肿需要结扎动脉导管。2例患者术后病程因积液时间延长而复杂化。所有患者术后14 - 48个月均存活且情况良好，全身饱和度（80 - 87%）和血流动力学指标令人满意。
这一有限的经验挑战了广泛持有的观点，即双向腔肺吻合术不能作为婴儿早期复杂心脏病的一期姑息治疗方法。需要更广泛的经验来确定这种方法的安全性和指征。
