BAFFLE FENESTRATION WITH SUBSEQUENT TRANSCATHETER CLOSURE - MODIFICATION OF THE FONTAN OPERATION FOR PATIENTS AT INCREASED RISK
BAFFLE FENESTRATION WITH SUBSEQUENT TRANSCATHETER CLOSURE - MODIFICATION OF THE FONTAN OPERATION FOR PATIENTS AT INCREASED RISK
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DOI：
10.1161/01.cir.82.5.1681
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发表时间：
1990-11-01
期刊：
影响因子：
37.8
通讯作者：
CASTANEDA, AR
中科院分区：
文献类型：
--
作者：
BRIDGES, ND;LOCK, JE;CASTANEDA, AR
心室功能障碍、肺血管阻力升高和残留的远端肺动脉扭曲导致 Fontan 手术后早期死亡；它们可能是暂时的或可逆的。挡板开窗允许从右向左分流，维持心输出量并限制右心房压力。在对连续 20 名患者进行改良 Fontan 修复时，通过手术创建了挡板开窗。危险因素包括肺动脉压18毫米汞柱或更高、舒张末期压力12毫米汞柱或更高、瓣膜反流、肺动脉扭曲、肺血管阻力2个伍兹单位或更高、心室流出道梗阻和复杂的解剖结构。 20 名患者中有 19 人幸存。术后平均动脉氧饱和度为86%，平均右心房压为15 mm Hg，平均胸腔积液持续时间为6天。 19 名幸存者中的 12 名耐受了早期测试封堵，并进行了永久性经导管伞封堵。由于心室功能障碍、肺动脉扭曲或主肺侧支循环，四名患者早期封堵试验失败，静脉氧饱和度显着下降，中心静脉压升高。在纠正这些异常后，四分之三的人成功地延迟了开窗关闭。
Ventricular dysfunction, elevated pulmonary vascular resistance, and residual distal pulmonary artery distortion contribute to early mortality after a Fontan operation; they may be transient or reversible. A baffle fenestration, allowing right-to-left shunting, maintains cardiac output and limits right atrial pressure. A baffle fenestration was surgically created at the time of a modified Fontan repair in 20 consecutive patients. Risk factors included pulmonary artery pressure of 18 mm Hg or more, end-diastolic pressure of 12 mm Hg or more, valvar regurgitation, pulmonary artery distortion, pulmonary vascular resistance of 2 Woods'' units or more, ventricular outflow obstruction, and complex anatomy. Nineteen of 20 patients survived. After the operation, mean arterial oxygen saturation was 86%, mean right atrial pressure was 15 mm Hg, and mean duration of pleural effusions was 6 days. Twelve of 19 survivors tolerated early test occlusion and had permanent transcatheter umbrella closure. Four patients failed early test occlusion, with a significant decrease in venous O2 saturation and a rise in central venous pressure, due to ventricular dysfunction, pulmonary artery distortion, or aortopulmonary collaterals. Three of four had successful late closure of the fenestration after correction of these abnormalities.