Kaulitz R, Luhmer I, Kallfelz H C
Department of Paediatric Cardiology, Children's Hospital, Medical School Hannover, Germany.
Cardiol Young. 1998 Jan;8(1):54-62. doi: 10.1017/s1047951100004637.
To assess the effect of a modified Fontan operation on systemic venous blood flow and the hepatic circulation, we compared 11 patients having an atriopulmonary connection and 35 with total cavopulmonary anastomosis. The Doppler echocardiographic study of the caval venous, hepatic venous and portal venous flow was performed so as to calculate the pulsatility ratio and the variation of flow with respiration. All patients had undergone cardiac catheterization. In addition, we included specific laboratory investigations to assess function of various organs. Significantly lower maximum velocities of flow at inspiration (0.31+/-0.12 m/sec vs 0.45+/-0.14 m/sec) and expiration (0.23+/-0.09 m/sec vs 0.32+/-0.11 m/sec), less pulsatility (0.43 vs 0.16) and a lower ratio of systolic to diastolic velocity (1.22 vs 1.85) were found in the patients having a cavopulmonary as compared to an atriopulmonary anastomosis. Peak velocities of hepatic venous flow during inspiration and expiration were significantly lower in those with a cavopulmonary anastomosis (p = 0.001 and p < 0.001, respectively). In these patients, forward flow was extremely dependent on respiration, with decrease or cessation of antegrade flow during expiration in 22 patients. The velocity of portal venous flow was also significantly lower in these patients, although the pulsatility ratio did not differ significantly between the groups (0.5+/-0.21 and 0.57+/-0.23, respectively). The ratio of inspiratory and expiratory velocities showed no significant difference between the groups, nor was there any correlation between the pulsatility ratio of the venous vessels or the ratio of peak flow velocities during expiration and the mean systemic venous/right atrial pressure on postoperative cardiac catheterization. Hypoproteinemia was found in 8 patients after total cavopulmonary anastomosis; 9 of 10 patients with protein C deficiency belonged to this group. The dependence of hepatic venous flow on respiration in the presence of a chronically elevated systemic venous pressure in patients after the total cavopulmonary anastomosis may influence hepatic function in the postoperative period.
为评估改良Fontan手术对体循环静脉血流及肝循环的影响，我们比较了11例采用心房肺连接术的患者和35例采用全腔肺吻合术的患者。进行了腔静脉、肝静脉和门静脉血流的多普勒超声心动图研究，以计算搏动指数和呼吸时血流的变化。所有患者均接受了心导管检查。此外，我们还进行了特定的实验室检查以评估各器官的功能。与心房肺吻合术患者相比，全腔肺吻合术患者吸气时（0.31±0.12米/秒对0.45±0.14米/秒）和呼气时（0.23±0.09米/秒对0.32±0.11米/秒）的最大血流速度显著降低，搏动性较小（0.43对0.16），收缩期与舒张期速度比值较低（1.22对1.85）。全腔肺吻合术患者吸气和呼气时肝静脉血流的峰值速度显著较低（分别为p = 0.001和p < 0.001）。在这些患者中，正向血流极度依赖呼吸，22例患者在呼气时顺行血流减少或停止。这些患者门静脉血流速度也显著较低，尽管两组间搏动指数无显著差异（分别为0.5±0.21和0.57±0.23）。两组间吸气和呼气速度比值无显著差异，术后心导管检查时静脉血管的搏动指数或呼气时峰值血流速度比值与平均体循环静脉/右心房压力之间也无相关性。全腔肺吻合术后8例患者出现低蛋白血症；10例蛋白C缺乏患者中有9例属于该组。全腔肺吻合术后患者体循环静脉压力长期升高时肝静脉血流对呼吸的依赖性可能会影响术后肝功能。
