Bradley S M, Mosca R S, Hennein H A, Crowley D C, Kulik T J, Bove E L
Department of Surgery, Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, USA.
Circulation. 1996 Nov 1;94(9 Suppl):II5-11.
Bidirectional superior cavopulmonary connection (BSCC) has become widely used in patients with univentricular AV connections. However, concerns remain about perioperative morbidity and mortality and about the adequacy of oxygenation after cavopulmonary connection in very young patients. This report examines our experience with BSCC in young infants to evaluate whether young age affects operative outcome, to examine the effect of young age on postoperative oxygenation, and to define the lower age limit for successful use of the procedure.
The records of the 85 consecutive patients < 6.5 months old who underwent BSCC from December 1990 through February 1995 were reviewed. The average patient age was 4.8 +/- 1.4 months (range, 5 weeks to 6.5 months), with 13 patients being < 3 months old. There were 5 hospital deaths (6%; 70% confidence limits, 3% to 10%). Pulmonary artery thrombosis occurred in 3 patients (4%; 70% confidence limits, 2% to 7%). Younger age was significantly associated with pulmonary artery thrombosis but not with operative death. Oxygenation (arterial PO2, and oxygen saturation) improved significantly and spontaneously over the first 48 hours after BSCC. Younger age had a significant adverse effect on oxygenation in the early postoperative period (first 48 hours).
BSCC can be performed successfully in infants < 6 months old and as young as 5 weeks old. Within this patient population, younger age is not associated with perioperative death but is associated with pulmonary artery thrombosis and postoperative hypoxemia. We suggest that BSCC may be performed any time beyond the neonatal period in symptomatic patients and may be delayed until 4 to 6 months of age if completely elective.
双向腔肺连接术（BSCC）已广泛应用于单心室房室连接患者。然而，对于围手术期发病率和死亡率以及极幼龄患者腔肺连接术后氧合是否充足仍存在担忧。本报告探讨我们在婴幼儿中进行BSCC的经验，以评估低龄是否影响手术结果，研究低龄对术后氧合的影响，并确定该手术成功应用的最低年龄限制。
回顾了1990年12月至1995年2月期间连续85例年龄小于6.5个月接受BSCC的患者记录。患者平均年龄为4.8±1.4个月（范围5周龄至6.5个月），其中13例小于3个月龄。有5例医院死亡（6%；70%可信区间，3%至10%）。3例患者发生肺动脉血栓形成（4%；70%可信区间，2%至7%）。低龄与肺动脉血栓形成显著相关，但与手术死亡无关。在BSCC后的头48小时内，氧合（动脉血氧分压和氧饱和度）显著且自发地改善。低龄在术后早期（头48小时）对氧合有显著不良影响。
BSCC可在6个月龄以下甚至5周龄的婴儿中成功实施。在这一患者群体中，低龄与围手术期死亡无关，但与肺动脉血栓形成和术后低氧血症有关。我们建议，对于有症状的患者，BSCC可在新生儿期之后的任何时间进行；如果是完全择期手术，可推迟至4至6个月龄。
