Factors that influence the development of atrial flutter after the Fontan operation
Factors that influence the development of atrial flutter after the Fontan operation
复制标题
DOI：
10.1016/s0022-5223(97)70402-1
复制
发表时间：
1997-01-01
影响因子：
6
通讯作者：
Walsh, EP
中科院分区：
文献类型：
--
作者：
Fishberger, SB;Wernovsky, G;Walsh, EP
目的：心房扑动是 Fontan 手术常见的、可能致命的并发症，但其发生的危险因素尚不明确，我们评估了可能预测接受 Fontan 手术的患者发生心房黄油的临床特征，方法：我们评估了 1973 年 4 月至 1991 年 7 月期间进行的 Fontan 手术的 334 名早期幸存者（平均随访时间，5.0 +/- 3.8 年），评估包括心电图、动态心电图监测Fontan 手术的修改包括心外导管 (n = 43)、心房肺吻合术 (n = 117) 或全腔肺吻合术 (n = 174)。根据心房扑动的发生情况对患者、时间和手术相关变量进行分析，结果：54 名患者 (16%) 发现心房扑动，平均Fontan 手术后 5.3 +/- 4.7 年（范围 0 至 19.7 年）。 Fontan 手术时年龄较大（12.4 +/- 7.6 对比 6.3 +/- 5.2 岁；p < 0.001）、随访间隔较长（8.7 +/- 3.9 对比 4.4 +/- 3.4 年；p < 0.001）、既往接受过房间隔切除术或肺动脉重建（p < 0.001）的患者心房扑动发生得更快，更有可能发生。 0.01），并且纽约心脏协会分级症状更差（p < 0.02），窦房结功能障碍的存在与心房扑动的发生率较高相关（p < 0.001），虽然全腔静脉肺吻合术患者中心房黄油的患病率较低，但该组的随访时间较短，解剖诊断、围手术期血流动力学和其他既往姑息性手术与心房扑动的发生率无关。心房扑动的发生率增加，多变量分析确定手术时年龄、随访时间、广泛的心房秃头和修复类型是与 Fontan 手术后心房扑动发生相关的因素，结论：Fontan 手术后心房扑动随着时间的推移继续发生，需要进一步随访以确定全腔肺吻合术是否会降低心房扑动的发生率。
Objectives: Atrial flutter is a frequent, potentially fatal complication of the Fontan operation, but risk factors for its development are ill defined, We evaluated clinical features that might predict the development of atrial butter in patients who had a Fontan operation, Methods: We evaluated 334 early survivors of a Fontan operation done between April 1973 and July 1991 (mean follow-up, 5.0 +/- 3.8 years), Evaluation included electrocardiography, Holter monitor recordings, and chart review, Modifications of the Fontan operation included an extracardiac conduit (n = 43), an atriopulmonary anastomosis (n = 117), or a total cavopulmonary anastomosis (n = 174), Patient, time, and procedure-related variables were analyzed with respect to the development of atrial flutter, Results: Atrial flutter was identified in 54 (16%) patients at a mean of 5.3 +/- 4.7 years (range 0 to 19.7 years) after Fontan operation. Atrial flutter developed sooner and was more likely to occur in patients who were older at the time of Fontan operation (12.4 +/- 7.6 vs 6.3 +/- 5.2 years; p < 0.001), had a longer follow-up interval (8.7 +/- 3.9 vs 4.4 +/- 3.4 years; p < 0.001), had a prior atrial septectomy or pulmonary artery reconstruction (p < 0.01), and had worse New York Heart Association class symptoms (p < 0.02), The presence of sinus node dysfunction was associated with a higher incidence of atrial flutter (p < 0.001), Although there was a lower prevalence of atrial butter in those patients with a total cavopulmonary anastomosis, the follow-up for this group was shorter, Anatomic diagnoses, perioperative hemodynamics, and other previous palliative operations were not associated with an increased incidence of atrial flutter, Multivariate analysis identified age at operation, duration of follow-up, extensive atrial balding, and type of repair as factors associated with the development of atrial flutter after Fontan operation, Conclusion: Atrial flutter continues to develop with time after the Fontan operation, Further follow-up is necessary to determine whether a total cavopulmonary anastomosis reduces the incidence of atrial flutter.