Stenbøg E V, Hjortdal V E, Emmertsen K, Hansen O K
Thoraxkirurgisk afdeling, Arhus Universitetshospital, Skejby Sygehus.
Ugeskr Laeger. 1997 Feb 10;159(7):946-51.
Between January 1990 and January 1995, 37 children and young adults with univentricular hearts were evaluated for total cavo-pulmonary connection (TCPC) or partial cavo-pulmonary connection (PCPC). Nineteen patients had tricuspid atresia, ten double-inlet left ventricle, five mitral atresia, and three had other complex univentricular lesions. Twenty-eight patients had previously been palliated by a systemic-pulmonary artery shunt or by pulmonary artery banding. All patients underwent physical examination, two-dimensional echo-cardiography, and cardiac catheterization. Suitability for TCPC was decided according to the modified Choussat criteria. Nine patients (24%), were judged unsuitable for any type of cava-pulmonary connection. Seventeen patients aged 5 (2-20) years underwent TCPC, and two patients awaited TCPC at follow-up (October 1995) Nine patients aged 10 (1-40) years had borderline morphology or haemodynamics and therefore underwent PCPC. One of these had, however, to be taken down immediately due to development of superior vena cava syndrome. The postoperative follow-up time was 20 (0.3 5.4) years. The 30-day, 1-, and 5-year survival rates (Kaplan-Meier) were 82%, 76%, and 76% after TCPC and 100%, 100%, and 100% after PCPC. All deaths were due to ventricular failure. At latest follow-up, all hospital survivors were in NYHA class I or II. All PCPC, and 85% of the TCPC patients were in sinus rhythm. All patients had good ventricular function. TCPC and PCPC can be performed in selected patients with univentricular hearts with an acceptable mortality and morbidity and result in significant functional improvement.
1990年1月至1995年1月期间，对37例单心室患儿及青年进行了全腔静脉-肺动脉连接术（TCPC）或部分腔静脉-肺动脉连接术（PCPC）评估。19例患者为三尖瓣闭锁，10例为双入口左心室，5例为二尖瓣闭锁，3例为其他复杂单心室病变。28例患者先前已接受体肺分流术或肺动脉环扎术姑息治疗。所有患者均接受了体格检查、二维超声心动图检查及心导管检查。根据改良的Choussat标准确定是否适合行TCPC。9例患者（24%）被判定不适合任何类型的腔静脉-肺动脉连接术。17例年龄为5岁（2至20岁）的患者接受了TCPC，2例患者在随访时（1995年10月）等待行TCPC。9例年龄为10岁（1至40岁）的患者形态或血流动力学处于临界状态，因此接受了PCPC。然而，其中1例因上腔静脉综合征的发生而不得不立即拆除手术。术后随访时间为20年（0.3至5.4年）。TCPC术后30天、1年和5年生存率（Kaplan-Meier法）分别为82%、76%和76%，PCPC术后分别为100%、100%和100%。所有死亡均因心室衰竭。在最近一次随访时，所有住院幸存者均为纽约心脏协会（NYHA）I级或II级。所有接受PCPC的患者以及85%接受TCPC的患者均为窦性心律。所有患者心室功能良好。对于选定的单心室患者，可进行TCPC和PCPC，死亡率和发病率可接受，并能显著改善功能。
