Somatic growth failure after the Fontan operation.
Somatic growth failure after the Fontan operation.
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Fontan 手术后体细胞生长障碍。
DOI：
10.1017/s1047951100008118
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发表时间：
2000
影响因子：
1
通讯作者：
Vetter,VL
中科院分区：
文献类型：
--
作者：
Cohen,MI;Bush,DM;FerryJr,RJ;Spray,TL;MoshangJr,T;Wernovsky,G;Vetter,VL
我们的研究旨在描述在婴儿期接受半Fontan手术，然后在儿童早期接受改良Fontan手术的功能性单心室心脏儿童的中期生长模式。生长障碍在先天性心脏畸形患者中很常见，可能与充血性心力衰竭和缺氧有关。单纯性损伤的修复似乎可以逆转生长迟缓。采用分阶段Fontan手术缓解功能性单心室生理可减少低氧血症和长期心室容量超负荷的不良反应。这种方法对体细胞生长的影响尚不清楚。回顾性分析了1990年1月至1995年12月在我院完成Fontan循环分期重建的所有功能性单心室心脏患儿的生长参数。所有儿童在手术前和Fontan手术后三年内每年进行一次测量。为了比较的目的，从兄弟姐妹和父母那里获得了数据。65例患者符合入选标准。半Fontan手术时体重的平均Z评分为-1.5 ± 1.2。在完成Fontan循环时（-0.91 ± 0.99），以及Fontan手术后的前两年，体重有所改善，但从未恢复正常。半Fontan和Fontan手术时身高的平均Z评分分别为-0.67 ± 1.1和-0.89 ± 1.2。在最近的随访中，平均年龄为6.1 ± 1.3岁，Fontan手术的平均时间为4.4 ± 1.4年，身高的平均Z评分为-1.15 ± 1.2，显著低于父母和兄弟姐妹的可比Z评分。在我们的经验中，功能性单心室心脏的儿童在Fontan手术后体重明显低于普通人群和他们的兄弟姐妹
Our study was designed to characterize the patterns of growth, in the medium term, of children with functionally univentricular hearts managed with a hemi-Fontan procedure in infancy, followed by a modified Fontan operation in early childhood. Failure of growth is common in patients with congenital cardiac malformations, and may be related to congestive heart failure and hypoxia. Repair of simple lesions appears to reverse the retardation in growth. Palliation of the functionally single ventricular physiology with a staged Fontan operation reduces the adverse effects of hypoxemia and prolonged ventricular volume overload. The impact of this approach on somatic growth is unknown. Retrospectively, we reviewed the parameters of growth of all children with functionally univentricular hearts followed primarily at our institution who had completed a staged construction of the Fontan circulation between January 1990 and December 1995. Measurements were available on all children prior to surgery, and annually for three years following the Fontan operation. Data was obtained on siblings and parents for comparative purposes. The criterions of eligibility for inclusion were satisfied by 65 patients. The mean Z score for weight was-1·5± 1·2 at the time of the hemi-Fontan operation. Weight improved by the time of completion of the Fontan circulation (−0·91 ±0·99), and for the first two years following the Fontan operation, but never normalized. The mean Z scores for height at the hemi-Fontan and Fontan operations were −0·67 ±1·1 and −0·89±1·2 respectively. At most recent follow-up, with a mean age of 6·1 ± 1·3 years, and a mean time from the Fontan operation of 4·4±1·4 years, the mean Z score for height was −1·15 ±1·2, and was significantly less than comparable Z scores for parents and siblings. In our experience, children with functionally univentricular hearts who have been palliated with a Fontan operation are significantly underweight and shorter than the general population and their siblings