Sidiropoulos A, Ritter J, Schneider M, Konertz W
Department of Cardiac Surgery, Charité, Berlin, Germany.
Eur J Cardiothorac Surg. 1998 May;13(5):509-12; discussion 512-3. doi: 10.1016/s1010-7940(98)00050-5.
Establishment of Fontan circulation in complex univentricular hearts often requires several surgical procedures. We developed a procedure which maintains the advantages of a staged approach, however, during the initial surgery additional preparatory measures are performed to allow subsequent non-surgical Fontan completion.
The operation is a lateral baffle Fontan procedure. The baffle bears multiple perforations to allow the inferior vena cava blood to drain into the systemic atrium. Total cavopulmonary connection is performed as usual and the cardiac end of the superior vena cava is subtotally banded. Formally the operation establishes a bi-directional Glenn physiology. During subsequent catheter intervention the banding of the superior vena cava is dilated and the holes in the baffle are closed with appropriate devices.
From April 1994 to December 1995, 18 children having at least two risk factors for Fontan operation received the above described operation. Ages ranged from 3 months to 15 years. Ten patients had one or more previous operations. Bypass time ranged from 86 to 128 min and cross clamp time from 14 to 79 min. O2 saturation after discontinuation of cardiopulmonary bypass was 76% (70-81%). The postoperative recovery of all patients was rapid with early extubation (mean 6 h) and discharge to the ward the morning of the first postoperative day. One patient died. No fluid retention as pericardial, pleural or abdominal fluid effusions occurred. At discharge O2 saturation was 77% (75-82%). In thirteen children successful conversion to total cavopulmonary connection with interventional debanding of the superior vena cava and closure of the fenestrations was performed. After a hospital stay of only a couple of days the children were discharged with normal O2 saturation after Fontan completion.
We suggest that this modification of the staged Fontan procedure reduces the need for surgical interventions by applying balloon angioplasty and occluder technology to this unique subset of patients.
在复杂单心室心脏中建立Fontan循环通常需要多次外科手术。我们开发了一种手术方法，该方法保留了分期手术的优点，然而，在初次手术期间会采取额外的准备措施，以便后续能通过非手术方式完成Fontan手术。
该手术为侧挡板Fontan手术。挡板上有多个穿孔，以使下腔静脉血流入体心房。全腔肺连接按常规进行，上腔静脉的心端部分结扎。从形式上看，该手术建立了双向Glenn生理状态。在随后的导管介入治疗中，扩张上腔静脉的结扎带，并用适当的装置封闭挡板上的孔。
1994年4月至1995年12月，18名至少有两个Fontan手术危险因素的儿童接受了上述手术。年龄范围为3个月至15岁。10名患者曾接受过一次或多次手术。体外循环时间为86至128分钟，主动脉阻断时间为14至79分钟。停止体外循环后的氧饱和度为76%（70 - 81%）。所有患者术后恢复迅速，早期拔管（平均6小时），术后第一天上午即可返回病房。1例患者死亡。未出现心包、胸腔或腹腔积液等液体潴留情况。出院时氧饱和度为77%（75 - 82%）。13名儿童通过对上腔静脉进行介入性解除结扎和封闭开窗成功转变为全腔肺连接。在仅住院几天之后，这些儿童在Fontan手术完成后以正常的氧饱和度出院。
我们认为，这种改良的分期Fontan手术通过对这一特殊患者群体应用球囊血管成形术和封堵器技术，减少了手术干预的需求。
