Assesment of mew oprative method using sutologous right atriun in order to improve the QOL in comlex heart defects.

全腔肺连接术（TCPC）的优点目前已得到公认。然而，在心房搏动力方面，原Fontan手术优于TCPC。因此，我们将自体右心房皮瓣的应用范围扩大到TCPC，并对10例接受TCPC手术的患者进行肺内多普勒超声心动图（flow wire）评估肺流量，并测量ANP、BNP即心脏激素。采用0.014英寸导丝型（flow wire） 15Mhz换能器，采用脉冲多普勒测量肺血流型。组I（N=6）有搏动血流信号，组II（N=4）无搏动。1组6例中3例为三尖瓣闭锁，另外3例为单室心脏。II组4例中3例为单室心脏，1例为纯肺闭锁。I组年龄为8.8(]SY.+-[)5.7岁，II组年龄为16.0(]SY.+-[)9.1岁。在由下腔静脉转路至肺动脉的手术中，I组全部采用自体右心房壁，II组2例。右房容积指数（ml/m<@D12@>D1）为30(]SY.+-。[1]第1组5例，第2组20例。[)8 .在第二组中。右心房射血分数（%）为33(]SY.+-。[1]第11组和第9组(]SY.+-。[2]在第二组中。ANP和BNP在两组间无明显变化趋势。结论：1)自体右心房壁在TCPC中可提供肺循环脉动血流。2)三尖瓣闭锁和年轻化是促进这种效应的因素。3) ANP和BNP即心脏激素在此评估中未被识别出趋势。

The adventages of total cavopulmonary connection (TCPC) have been acknowledged at this present. With regard to atrial pulsatile force, however, the original Fontan procedure is superior to TCPC.So, we have extended the application of using autologous right atrial flap to TCPC,and pulmonary flow was assessed by intrapulmonary doppler echo cardiography (Flow wire) and measured ANP,BNP so called cardiac hormone in ten patients who underwent TCPC procedure.Pulmonary flow pattern was obtained by pulse doppler, using 15Mhz transducer of 0.014inch guide wire type (Flow wire).Group I(N=6) showed pulsatile flow signal and group II(N=4) was not pulsatile. Three of six in group I were tricuspid atresia and the other three were univentricular heart. Three of four in group II were univentricular heart and one was pure pulmonary atresia. Age was 8.8(]SY.+-。[)5.7 years in group I and 16.0(]SY.+-。[)9.1 years in group II.On the procedure of rerouting from inferior venae cavae to the pulmonary artery, the autologous right atrial wall was used in all cases of group I and two cases of group II.Right atrial volume index (ml/m<@D12@>D1) was 30(]SY.+-。[)5 in group I and 20(]SY.+-。[)8 in group II.The ejection fraction (%) of right atrium was 33(]SY.+-。[)11 in group I and 9(]SY.+-。[)2 in group II.ANP and BNP were recognized no tendency among two groups.Conclusion : 1) Using autologous right atrial wall in TCPC could provide pulsatile flow in pulmonary circulation. 2) Accelerating factors of this effect are tricuspid atresia and yonger age. 3) ANP and BNP so called cardiac hormone were recognized no tendency in this assesment.