Extending the limits for modified Fontan procedures.
Extending the limits for modified Fontan procedures.
复制标题
扩大修改后的 Fontan 程序的限制。
DOI：
10.1016/s0022-5223(19)35818-0
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发表时间：
1986
期刊：
影响因子：
--
通讯作者：
A. Castañeda
中科院分区：
文献类型：
--
作者：
J. Mayer;H. Helgason;R. Jonas;P. Lang;F. J. Vargas;N. Cook;A. Castañeda
在心房吻合术（Fontan-Kreutzer）的早期开发过程中，Fontan小组提出了许多生理和解剖学限制作为选择标准。在1973年至1985年接受改良Fontan手术的167例连续患者中，109例（65%）患者在年龄、体静脉或肺静脉连接异常、肺动脉扭曲和肺动脉压方面超过了一项或多项原始选择标准。26例患者的平均肺动脉压大于15 mm Hg，16例手术存活（62%）。19例患者存在体静脉和/或肺静脉连接异常，16例存活（84%）。4岁以下44例，存活26例（59%）。25例患者年龄大于15岁，23例（92%）在Fontan手术中存活。34例患者出现肺动脉扭曲，与既往姑息性手术有关。这34例患者中有17例在改良Fontan手术后存活（50%）。肺小动脉阻力大于2U·m2者26例，存活14例（54%），肺小动脉阻力小于2U·m2者93例，存活81例（87%）。多变量分析显示，肺小动脉阻力和肺动脉扭曲对生存率有显著的负面影响，但年龄和体静脉和/或肺静脉连接异常则无影响。肺动脉压不是预后的独立预测因子。结果表明，在年龄和肺静脉或体静脉连接异常方面，可能会超过最初的标准。如果肺小动脉阻力低，单纯肺动脉压力不应禁忌Fontan手术。既往姑息性手术导致的肺动脉扭曲和肺小动脉阻力升高会增加Fontan手术的风险。
During the early development of atriopulmonary anastomotic operations (Fontan-Kreutzer), a number of physiologic and anatomical limits were proposed by the Fontan group as selection criteria. Among 167 consecutive patients undergoing modified Fontan procedures from 1973 through 1985, 109 (65%) patients exceeded one or more of the original selection criteria in areas of age, anomalies of systemic or pulmonary venous connection, pulmonary artery distortion, and pulmonary artery pressure. Twenty-six patients had a mean pulmonary artery pressure greater than 15 mm Hg, with 16 operative survivors (62%). Nineteen patients had anomalies of systemic and/or pulmonary venous connection, and 16 survived (84%). There were 44 patients under the age of 4 years, and 26 survived (59%). Twenty-five patients were older than 15 years, and 23 (92%) survived the Fontan procedure. Pulmonary artery distortion, relating to prior palliative operations, was found in 34 patients. Seventeen of these 34 survived a modified Fontan procedure (50%). Twenty-six patients had a pulmonary arteriolar resistance more than 2 Wood units times square meter, and 14 survived (54%), whereas 81 of 93 with a pulmonary arteriolar resistance of less than 2 U · m2survived (87%). Multivariate analysis showed that pulmonary arteriolar resistance and pulmonary artery distortion had a significant, negative impact on survival, but age and anomalies of systemic and/or pulmonary venous connection did not. Pulmonary artery pressure was not an independent predictor of outcome. The results show that the original criteria may be exceeded in the areas of age and anomalies of pulmonary or systemic venous connection. Pulmonary artery pressure alone should not contraindicate a Fontan procedure if pulmonary arteriolar resistance is low. Pulmonary artery distortion from a prior palliative operation and elevated pulmonary arteriolar resistance increase the risk of a Fontan procedure.
血浆高密度脂蛋白胆固醇与总密度脂蛋白胆固醇和低密度脂蛋白胆固醇的比率：特定北美人群的年龄相关变化以及种族和性别差异。
影响因子：
37.8
作者：
Green,MS;Heiss,G;Rifkind,BM;Cooper,GR;Williams,OD;Tyroler,HA
通讯作者：
Tyroler,HA