CENTRAL PULMONARY-ARTERY GROWTH-PATTERNS AFTER THE BIDIRECTIONAL GLENN PROCEDURE
CENTRAL PULMONARY-ARTERY GROWTH-PATTERNS AFTER THE BIDIRECTIONAL GLENN PROCEDURE
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DOI：
10.1016/s0022-5223(94)70049-4
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发表时间：
1994-05-01
影响因子：
6
通讯作者：
BEEKMAN, RH
中科院分区：
文献类型：
--
作者：
MENDELSOHN, AM;BOVE, EL;BEEKMAN, RH
本文对1989年10月至1992年2月间30例单室心脏解剖患者行双向Glenn手术前后肺动脉大小和血流动力学的变化进行了研究。比较双向Glenn手术前后17.6 +/- 1.6个月的血管造影和血流动力学检查。在随访研究中，双向格伦分流术同侧肺动脉直径无明显变化，而双向格伦分流术对侧肺动脉直径明显减小（p = 0.04）。双向Glenn手术后总横断肺动脉面积Nakata指数降低32% （p = 0.004）。随访时，肺总血流量和平均肺动脉压下降，动脉氧饱和度升高。然而，这些变化与观察到的肺动脉大小变化没有相关性。经线性回归分析，双向Glenn手术前的Nakata指数与Nakata指数的绝对变化呈显著相关（r = 0.83）。仅在双向Glenn分流术放置超过15个月的患者中田指数显著下降。30例患者中16例随后行全腔隙肺吻合术，7例同时行肺动脉重建手术。双向Glenn手术后超过15个月观察到的肺动脉大小变化可能对单心室解剖的儿童后续Fontan修复有影响。
The changes in pulmonary artery size and hemodynamics in 30 patients with univentricular cardiac anatomy were examined before and after bidirectional Glenn procedures done between October 1989 and February 1992. Serial angiographic and hemodynamic examinations before and 17.6 +/- 1.6 months after bidirectional Glenn procedures were compared. At the follow-up study there was no significant change in diameter of the pulmonary artery ipsilateral to the bidirectional Glenn shunt, however, a significant decrease was noted in the diameter of the pulmonary artery contralateral to the bidirectional Glenn shunt (p = 0.04). There was also a 32% decrease in the Nakata index of total cross-sectional pulmonary artery area after the bidirectional Glenn procedure (p = 0.004). Total pulmonary blood flow and mean pulmonary artery pressure had decreased, and arterial oxygen saturation had increased at follow-up. These changes, however, did not correlate,vith the observed changes in pulmonary artery size. By linear regression analysis, a significant relationship was identified between the Nakata index before the bidirectional Glenn procedure and the absolute change in Nakata index (r = 0.83). A significant decrease in Nakata index occurred only in patients with a bidirectional Glenn shunt in place more than 15 months. Sixteen of the 30 patients subsequently underwent total cavopulmonary anastomosis with 7 requiring concurrent surgical pulmonary artery reconstruction. Changes in pulmonary artery size observed more than 15 months after the bidirectional Glenn procedure may have implications for subsequent Fontan repair in children with univentricular anatomy.