Experimental study for the bypass of the right heart (Fontan procedure) Evaluation of the bidirectional cavopulmonary connection for Fontan Procedure

右房-肺动脉搭桥术(即所谓的Fontan手术)后，肝肿大和心律失常通常是由较低的心房压力引起的，临床上已证实双向腔肺分流术联合Fontan手术可减少这些并发症的发生。然而，双向腔肺分流术降低右房负荷的机制尚不清楚，因此，我们研究了双向腔肺分流术对血流动力学和心房轻盈的影响。4只麻醉犬分别接受了Fontan手术加三尖瓣关闭和双向腔肺分流术。所有的狗都保持正常的窦性心律。在心率(137和22对136和23次/分)、心输出量(0.95和0.20对0.91和0.91；正和0.26 L/分钟)、平均血压(37.0和34.8和34.8；gt；)方面，Fontan手术(双向腔肺分流术关闭)和Fontan手术和双向腔肺分流术之间没有统计学差异。左心房压(5.7&lt；+-lt；4.3对4.9&lt；+-lt；4.1 mm Hg)、上腔静脉压(14.9&lt；+-lt；2.7对15.1&lt；2.9 mm Hg)和右房压(16.6&lt；+-lt；4.0对16)。1.8%)(p&lt；0.05这一结果表明，双向下腔静脉分流术联合Fontan手术可以减少右房肌应力。这可能会改善术后肝肿大和心律失常。

A hepatomegaly and arrhythmias are often induced by high light atrial pressure after right atrium-pulmonary artery bypass (so-called Fontan procedure).Clinically, long-term benefit that these complications are reduced by the bidirectional cavopulmonary shunt in conjunction with Fontan procedure has been demonstrated. However, the mechanism of reducing right atrial load by the bidirectional cavopulmonary shunt is unknown.Therefore, the effects of this operation on hemodynamics and light atrium were studied.Four anesthetized dogs were underwent both a Fontan procedure with closure of tricuspid valve and a bidirectional cavopulmonary shunt. All dogs kept normal sinus rhythm.There were no statistical differences between only a Fontan procedure (bidirectional cavopulmonary shunt closed) and a Fontan procedure with bidirectional cavopulmonary shunt in heart rate (137<plus-minus>22 versus 136<plus-minus>23 bpm), cardiac output (O. 95<plus-minus>0.20 versus 0.91<plus-minus>0.26 l/min), mean blood pressure (37.0<plus-minus>9.0 versus 34.8<plus-minus>7.6 mmHg), Ieft atrial pressure (5.7<plus-minus>4.3 versus 4.9<plus-minus>4.1 mmHg) superior vena caval pressure (14.9<plus-minus>2.7 versus 15.1<plus-minus>2.9 mmHg) and right atrial pressure (16.6<plus-minus>4.0 versus 16There was a significant difference in right atrial myocardial length(100 versus 97.0<plus-minus>1.8%) (p<0.05This result shows that a bidirectional cavopuhnonary shunt in conjunction with a Fontan procedure decreases a right atrial muscle stress. This may improve postoperative hepatomegaly and arrliythmias.