Borini I, Marasini M, Dalmonte P, Corazza G, Lerzo F, Cervo G, Moretti R, Ribaldone D, Bertolini A, Zannini L
Divisione di Cardiochirurgia e Chirurgia Vascolare, Istituto G. Gaslini, Genova.
G Ital Cardiol. 1997 Jun;27(6):577-82.
While Fontan operation is considered a palliative procedure for the treatment of complex congenital heart disease, its morbidity and mortality are certainly not negligible, especially in high-risk patients. In our opinion, a bidirectional cavo-pulmonary anastomosis with an additional source of blood flow to the lungs (Blalock-Taussig shunt, pulmonary artery banding, native pulmonary stenosis) represents a valuable surgical option in this subset of patients. From November 1992 to September 1994, sixteen patients with complex congenital heart disease underwent bidirectional cavo-pulmonary anastomosis, leaving an additional source of blood flow in place (modified Blalock-Taussig shunt in 9 cases, pulmonary artery banding in 6 cases, native pulmonary stenosis in 1 case). Eight of these patients (50%) were reinvestigated after a mean follow-up of 15.7 months (range 1-26 m). It has been possible to differentiate two types of pulmonary blood flow, according to the nature of the additional flow source; in the case of cavo-pulmonary anastomosis and pulmonary artery banding or pulmonary stenosis, pulmonary blood flow was pulsatile and evenly distributed to both lungs, while in the case of bidirectional cavo-pulmonary anastomosis and Blalock-Taussig shunt, pulmonary flow was non pulsatile and asymmetric (angiographic criteria). There were no hospital deaths. Late mortality was 12.5% (2 pts) due to worsening of atrioventricular valve regurgitation. In one of these two patients, prolonged pleural and pericardial effusion occurred. In conclusion, bidirectional cavo-pulmonary anastomosis with an additional flow source is a good alternative to classic or fenestrated Fontan operation in the treatment of complex congenital heart disease. The best results are obtained with an additional flow source represented by pulmonary artery banding or pulmonary stenosis, due to pulsatility and uniform distribution of blood flow in the pulmonary district. Morbility and mortality compare favorably with the rates observed in classic or fenestrated Fontan operation.
虽然Fontan手术被认为是治疗复杂先天性心脏病的姑息性手术，但其发病率和死亡率肯定不可忽视，尤其是在高危患者中。我们认为，双向腔肺吻合术并附加肺部血流来源（Blalock-Taussig分流术、肺动脉环扎术、先天性肺动脉狭窄）是这类患者中有价值的手术选择。1992年11月至1994年9月，16例复杂先天性心脏病患者接受了双向腔肺吻合术，并保留了额外的血流来源（9例为改良Blalock-Taussig分流术，6例为肺动脉环扎术，1例为先天性肺动脉狭窄）。其中8例患者（50%）在平均随访15.7个月（范围1 - 26个月）后接受了复查。根据额外血流来源的性质，可以区分出两种类型的肺血流；在腔肺吻合术和肺动脉环扎术或肺动脉狭窄的情况下，肺血流是搏动性的，且均匀分布于双肺，而在双向腔肺吻合术和Blalock-Taussig分流术的情况下，肺血流是非搏动性的且不对称（血管造影标准）。无住院死亡病例。晚期死亡率为12.5%（2例），原因是房室瓣反流加重。在这两名患者中的一名，出现了长期的胸腔和心包积液。总之，在治疗复杂先天性心脏病时，附加血流来源的双向腔肺吻合术是经典或开窗Fontan手术的良好替代方案。由于肺区血流的搏动性和均匀分布，以肺动脉环扎术或肺动脉狭窄作为额外血流来源可获得最佳效果。其发病率和死亡率与经典或开窗Fontan手术观察到的比率相比更有利。
