Yamagishi M, Nakamura Y, Kanazawa T, Kawada N
Division of Cardiovascular Surgery, Saitama Children's Medical Center, Japan.
Kyobu Geka. 1997 Jun;50(6):437-43; discussion 443-6.
Long-term conventional pulmonary artery banding deteriorates ventricular function in patients who have univentricular atrioventricular connection with subaortic obstruction. Protection of the pulmonary vascular bed and early relief of subaortic stenosis is essential to improve the outcome after Fontan operation. From January 1995 through January 1996, three infants underwent open heart palliation because of univentricular atrioventricular connection with subaortic stenosis. All infants had discordant ventriculoarterial connection. One infant underwent the Norwood procedure (patient 1). Two infants underwent palliative arterial switch operation, one with repair of aortic arch and a Blalock-Taussig shunt (patient 2) and the other with endoluminal pulmonary artery banding (patient 3). Patient 3 required a subsequent conventional pulmonary arterial banding. The postoperative recovery period were smooth in the all infants. All infants kept sufficient PO2 ranging from 34 to 37 mmHg postoperatively. On follow-up after 16 months pulmonary artery index decreased in patient 1. On the other hand, angiogram demonstrated satisfactory pulmonary arterial growth in patient 2. There were two late death, occurring in patient 1 (sudden death) and patient 3 (pneumonia). Patient 2 awaits a Fontan type procedure. It is difficult to adjust appropriate blood flow through a Blalock-Taussing shunt and a surgically isolated pulmonary artery is capable of inducing pulmonary distortion after Damus-Norwoood type operation. Whereas natural regulation of the pulmonary arterial blood flow by a restrictive ventricular outflow tract is come up after a palliative arterial switch operation. Palliative arterial switch operation is an useful alternative open heart palliation for neonates and early infants who had univentricular atrioventricular connection with subaortic stenosis.
对于具有单心室房室连接并伴有主动脉下梗阻的患者，长期进行传统的肺动脉环扎术会使心室功能恶化。保护肺血管床并早期解除主动脉下狭窄对于改善Fontan手术后的预后至关重要。1995年1月至1996年1月，三名婴儿因单心室房室连接并伴有主动脉下狭窄接受了心脏直视姑息手术。所有婴儿均为心室动脉连接不一致。一名婴儿接受了Norwood手术（患者1）。两名婴儿接受了姑息性动脉调转手术，一名同时进行了主动脉弓修复和Blalock-Taussig分流术（患者2），另一名进行了腔内肺动脉环扎术（患者3）。患者3随后需要进行传统的肺动脉环扎术。所有婴儿术后恢复期均顺利。所有婴儿术后的动脉血氧分压均保持在34至37 mmHg之间。随访16个月后，患者1的肺动脉指数下降。另一方面，血管造影显示患者2的肺动脉生长情况良好。有两例晚期死亡，分别发生在患者1（猝死）和患者3（肺炎）。患者2等待进行Fontan类手术。通过Blalock-Taussig分流术很难调节合适的血流量，并且在Damus-Norwood类手术后，手术分离的肺动脉会导致肺扭曲。而姑息性动脉调转手术后，可通过限制性心室流出道对肺动脉血流进行自然调节。对于具有单心室房室连接并伴有主动脉下狭窄的新生儿和早期婴儿，姑息性动脉调转手术是一种有用的心脏直视姑息替代方法。
