Optimal conduit size for extracardiac Fontan operation
Optimal conduit size for extracardiac Fontan operation
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DOI：
10.1016/s1010-7940(00)00593-5
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发表时间：
2000-12-01
影响因子：
3.4
通讯作者：
Hetzer, R
中科院分区：
文献类型：
--
作者：
Alexi-Meskishvili, V;Ovroutski, S;Hetzer, R
背景：缺乏管道生长潜力和血栓形成是心外Fontan手术（ECFO）的主要缺点。根据患者年龄和下腔静脉直径的最佳管道尺寸尚未确定。目的：我们着手确定是否可以在ECFO之前确定导管的最佳尺寸。方法：对20例ECFO术后患者的实际和预期年龄相关的下腔静脉直径与心外管道直径进行比较。在另外50名儿童和成人患者中，测量了下腔静脉心包内部分与右肺动脉下表面之间的距离（IVC-RPA）。分析了导管血栓形成病例。结果如下：下腔静脉的实际直径是可变的，与人体测量数据和预期直径具有弱相关性（R = 0.07-0.23，P = 0.32-0.76）。NC-RPA距离与身高相关（R = 0.87，P = 0.0001），但也是可变的。在2-4岁和体重12-15 kg时，IVC直径和IVC-RPA距离等于成人值的60-80%。2例Fontan血流动力学不良和导管过大的患者发生导管血栓形成。结论：考虑到下腔静脉的大小，ECFO可以在2-3岁和体重12-15 kg时进行，此时可以植入血流动力学最佳的几乎成人大小的管道。根据实际下腔静脉直径和IVC-RPA距离，有必要对管道进行优化。术后应考虑抗凝，以防止Fontan循环欠佳患者的管道血栓形成（C）2000 Elsevier Science B. V.保留所有权利。
Background: Lack of conduit growth potential and thrombogenicity are the main drawbacks of the extracardiac Fontan operation (ECFO). Optimal size of the conduit according to the patients age and inferior vena cava diameter has not been established. Objectives: We set out to ascertain whether the optimal dimensions of the conduit could be determined before an ECFO. Methods: Actual and expected age-related inferior vena cava diameters were compared with the extracardiac conduit diameter in 20 patients after ECFO. In 50 other pediatric and adult patients, the distance between intrapericardial part of the inferior vena cava and the undersurface of the right pulmonary artery (IVC-RPA) was measured. Cases of conduit thrombosis were analyzed. Results: The actual diameter of the inferior vena cava was variable and has a weak correlation with anthropmetric data and expected diameter (R = 0.07-0.23, P = 0.32-0.76). The NC-RPA distance correlated with height (R = 0.87, P = 0.0001), but was also variable. At the age of 2-4 years and body weight 12-15 kg IVC diameter and IVC-RPA distance are equal to 60-80% of adult values. Conduit thrombosis developed in two patients with unfavorable Fontan hemodynamics and oversized conduits. Conclusions: Considering the inferior vena cava size, ECFO may be performed at the age of 2-3 years and at a body weight 12-15 kg, when a hemodynamically optimal almost adult sized conduit can be implanted. Optimization of the conduit is necessary on the basis of the actual inferior vena cava diameter and IVC-RPA distance. Anticoagulation postoperatively should be considered to prevent conduit thrombosis in patients with suboptimal Fontan circulation (C) 2000 Elsevier Science B.V. All rights reserved.