Right ventricle to pulmonary artery shunt as palliative operation for patients with severe cyanotic congenital heart disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 浮志坤 ¹ , 張向立 ¹ , 楊慧娟 ¹ , 劉洋 ¹ , 朱勇峰 ¹ , 楊恒 ¹ , 郭琳 ²

1. ;
2. ;

Corresponding?author：

浮志坤, Email: fuzhikun@126.com

Keywords：

姑息手術; 右室-肺動脈連接術; 先天性心臟病

DOI：

10.7507/1007-4848.201606026

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

目的探討姑息性右室-肺動脈連接術在重癥紫紺型先天性心臟病治療中的臨床應用。方法回顧性分析鄭州市第七人民醫院心臟外科 2011 年 1 月至 2015 年 1 月期間所有行姑息性右室-肺動脈連接術治療的重癥紫紺型先天性心臟病患者 25 例的臨床資料，其中男 17 例、女 8 例，年齡 31（5～108）個月，體重 3.5～37.2（12.82±6.73）kg。結果 25 例姑息性右室-肺動脈連接術后早期死亡 2 例（術后 30 d 內），早期死亡率 8.0%（2/25）。患者術后動脈血氧飽和度與術前差異有統計學意義（62.43%±7.83%vs. 81.62%±6.25%，P<0.05）。術后隨訪 6 個月至 3 年（每 3 個月復查一次超聲心動圖），23 例患者 McGoon 比值（1.05±0.14vs. 1.61±0.18，P<0.05）和 Nakata 指數[（112.37±14.38）mm²/m² vs. （165.74±22.62） mm²/m²，P<0.05]均明顯上升，且差異有統計學意義。17 例患者行二期根治手術治療。結論姑息性右室-肺動脈連接術能夠有效促進重癥紫紺型先天性心臟病患者的自身肺血管床發育，為行二期根治術創造條件。

Citation： 浮志坤, 張向立, 楊慧娟, 劉洋, 朱勇峰, 楊恒, 郭琳. Right ventricle to pulmonary artery shunt as palliative operation for patients with severe cyanotic congenital heart disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(10): 811-814. doi: 10.7507/1007-4848.201606026 Copy

1.	Murthy K, Reddy KP, Nagarajan R, et al. Management of ventricular septal defect with pulmonary atresia and major aorto pulmonary collateral arteries: Challenges and controversies. Ann Pediatr Cardiol, 2010, 3(2): 127-135.
2.	徐朝軍, 宋嵐, 尹曉清, 等. 改良 B-T 分流術在肺血減少型先天性心臟病中的臨床應用. 中國胸心血管外科臨床雜志, 2015, 22(5): 450-453.0.
3.	Liava'A M, Brizard CP, Konstantinov IE, et al. Pulmonary atresia, ventricular septal defect, and major aortopulmonary collaterals: neonatal pulmonary artery rehabilitation without unifocalization. Ann Thorac Surg, 2012, 93(1): 185-191.
4.	Gerelli S, van Steenberghe M, Murtuza B, et al. Neonatal right ventricle to pulmonary connection as a palliative procedure for pulmonary atresia with ventricular septal defect or severe tetralogy of Fallot. Eur J Cardiothorac Surg, 2014, 45(2): 278- 288.
5.	O'Connor MJ, Ravishankar C, Ballweg JA, et al. Early systemic-to-pulmonary artery shunt intervention in neonates with congenital heart disease. J Thorac Cardiovasc Surg, 2011, 142(1): 106-112.
6.	Kim H, Sung SC, Chang YH, et al. Outcome of staged repair of tetralogy of fallot with pulmonary atresia and a ductus-dependent pulmonary circulation: should primary repair be considered? Korean J Thorac Cardiovasc Surg, 2011, 44(6): 392-398.
7.	魯中原, 李守軍, 王旭, 等. 體-肺動脈分流與右室肺動脈連接術治療肺動脈閉鎖合并室間隔缺損術后早期療效的對比研究. 中國胸心血管外科臨床雜志, 2014, 21(4): 468-472.0.
8.	Mumtaz MA, Rosenthal G, Qureshi A, et al. Melbourne shunt promotes growth of diminutive central pulmonary arteries in patients with pulmonary atresia, ventricular septal defect, and systemic-to-pulmonary collateral arteries. Ann Thorac Surg, 2008, 85(6): 2079- 2084.
9.	Fang M, Wang H, Jin Y, et al. Development of pulmonary arteries after a central end-to-side shunt in patients with pulmonary atresia, ventricular septal defect, and diminutive pulmonary arteries. Thorac Cardiovasc Surg, 2014, 62(3): 211-215.
10.	Kim H, Sung SC, Choi KH, et al. A central shunt to rehabilitate diminutive pulmonary arteries in patients with pulmonary atresia with ventricular septal defect. J Thorac Cardiovasc Surg, 2015, 149(2): 515-520.
11.	Dragulescu A, Kammache I, Fouilloux V, et al. Long-term results of pulmonary artery rehabilitation in patients with pulmonary atresia, ventricular septal defect, pulmonary artery hypoplasia, and major aortopulmonary collaterals. J Thorac Cardiovasc Surg, 2011, 142(6): 1374-1380.
12.	張浩, 王德, 花中東, 等. 姑息性右心室肺動脈連接術在肺動脈閉鎖合并室間隔缺損治療中的應用. 中國胸心血管外科臨床雜志, 2013, 20(2): 135-138.0.
13.	Fouilloux V, Bonello B, Kammache I, et al. Management of patients with pulmonary atresia, ventricular septal defect, hypoplastic pulmonary arteries and major aorto-pulmonary collaterals: Focus on the strategy of rehabilitation of the native pulmonary arteries. Arch Cardiovasc Dis, 2012, 105(12): 666-675.
14.	鄧喜成, 沈向東, 郭少先, 等. 姑息手術在肺動脈閉鎖合并室間隔缺損分期矯治中的應用. 中國胸心血管外科臨床雜志, 2011, 18(2): 104-108.0.
15.	Amark KM, Karamlou T, O'Carroll A, et al. Independent factors associated with mortality, reintervention, and achievement of complete repair in children with pulmonary atresia with ventricular septal defect. J Am Coll Cardiol, 2006, 47(7): 1448-1456.
16.	Watanabe N, Anagnostopoulos PV, Shinkawa T, et al. Size of the right ventricle-to-pulmonary artery conduit impacts mid-term outcome after the Norwood procedure in patients weighing less than 3 kg. J Thorac Cardiovasc Surg, 2012, 144(5): 1091-1094.
17.	劉錦紛, 陳會文, 蘇肇伉, 等. Gore-tex 管重建前向性肺循環姑息性治療法洛氏四聯癥合并肺動脈閉鎖. 中華胸心血管外科雜志, 2006, 22(2): 73-75.0.
18.	Zhang Y, Hua Z, Yang K, et al. Outcomes of the rehabilitative procedure for patients with pulmonary atresia, ventricular septal defect and hypoplastic pulmonary arteries beyond the infant period. Eur J Cardiothorac Surg, 2014, 46(2): 297-303.
19.	鄭景浩, 徐志偉, 劉錦紛, 等. 肺動脈閉鎖合并室間隔缺損和 MAPCA 手術理念探討. 中華胸心血管外科雜志, 2014, 30(5): 257-260.0.
20.	周誠, 董念國, 杜心靈, 等. 姑息性手術在復雜先天性心臟病患者中的應用.中國胸心血管外科臨床雜志, 2012, 19(5): 494-497.0.

1. Murthy K, Reddy KP, Nagarajan R, et al. Management of ventricular septal defect with pulmonary atresia and major aorto pulmonary collateral arteries: Challenges and controversies. Ann Pediatr Cardiol, 2010, 3(2): 127-135.
2. 徐朝軍, 宋嵐, 尹曉清, 等. 改良 B-T 分流術在肺血減少型先天性心臟病中的臨床應用. 中國胸心血管外科臨床雜志, 2015, 22(5): 450-453.0.
3. Liava'A M, Brizard CP, Konstantinov IE, et al. Pulmonary atresia, ventricular septal defect, and major aortopulmonary collaterals: neonatal pulmonary artery rehabilitation without unifocalization. Ann Thorac Surg, 2012, 93(1): 185-191.
4. Gerelli S, van Steenberghe M, Murtuza B, et al. Neonatal right ventricle to pulmonary connection as a palliative procedure for pulmonary atresia with ventricular septal defect or severe tetralogy of Fallot. Eur J Cardiothorac Surg, 2014, 45(2): 278- 288.
5. O'Connor MJ, Ravishankar C, Ballweg JA, et al. Early systemic-to-pulmonary artery shunt intervention in neonates with congenital heart disease. J Thorac Cardiovasc Surg, 2011, 142(1): 106-112.
6. Kim H, Sung SC, Chang YH, et al. Outcome of staged repair of tetralogy of fallot with pulmonary atresia and a ductus-dependent pulmonary circulation: should primary repair be considered? Korean J Thorac Cardiovasc Surg, 2011, 44(6): 392-398.
7. 魯中原, 李守軍, 王旭, 等. 體-肺動脈分流與右室肺動脈連接術治療肺動脈閉鎖合并室間隔缺損術后早期療效的對比研究. 中國胸心血管外科臨床雜志, 2014, 21(4): 468-472.0.
8. Mumtaz MA, Rosenthal G, Qureshi A, et al. Melbourne shunt promotes growth of diminutive central pulmonary arteries in patients with pulmonary atresia, ventricular septal defect, and systemic-to-pulmonary collateral arteries. Ann Thorac Surg, 2008, 85(6): 2079- 2084.
9. Fang M, Wang H, Jin Y, et al. Development of pulmonary arteries after a central end-to-side shunt in patients with pulmonary atresia, ventricular septal defect, and diminutive pulmonary arteries. Thorac Cardiovasc Surg, 2014, 62(3): 211-215.
10. Kim H, Sung SC, Choi KH, et al. A central shunt to rehabilitate diminutive pulmonary arteries in patients with pulmonary atresia with ventricular septal defect. J Thorac Cardiovasc Surg, 2015, 149(2): 515-520.
11. Dragulescu A, Kammache I, Fouilloux V, et al. Long-term results of pulmonary artery rehabilitation in patients with pulmonary atresia, ventricular septal defect, pulmonary artery hypoplasia, and major aortopulmonary collaterals. J Thorac Cardiovasc Surg, 2011, 142(6): 1374-1380.
12. 張浩, 王德, 花中東, 等. 姑息性右心室肺動脈連接術在肺動脈閉鎖合并室間隔缺損治療中的應用. 中國胸心血管外科臨床雜志, 2013, 20(2): 135-138.0.
13. Fouilloux V, Bonello B, Kammache I, et al. Management of patients with pulmonary atresia, ventricular septal defect, hypoplastic pulmonary arteries and major aorto-pulmonary collaterals: Focus on the strategy of rehabilitation of the native pulmonary arteries. Arch Cardiovasc Dis, 2012, 105(12): 666-675.
14. 鄧喜成, 沈向東, 郭少先, 等. 姑息手術在肺動脈閉鎖合并室間隔缺損分期矯治中的應用. 中國胸心血管外科臨床雜志, 2011, 18(2): 104-108.0.
15. Amark KM, Karamlou T, O'Carroll A, et al. Independent factors associated with mortality, reintervention, and achievement of complete repair in children with pulmonary atresia with ventricular septal defect. J Am Coll Cardiol, 2006, 47(7): 1448-1456.
16. Watanabe N, Anagnostopoulos PV, Shinkawa T, et al. Size of the right ventricle-to-pulmonary artery conduit impacts mid-term outcome after the Norwood procedure in patients weighing less than 3 kg. J Thorac Cardiovasc Surg, 2012, 144(5): 1091-1094.
17. 劉錦紛, 陳會文, 蘇肇伉, 等. Gore-tex 管重建前向性肺循環姑息性治療法洛氏四聯癥合并肺動脈閉鎖. 中華胸心血管外科雜志, 2006, 22(2): 73-75.0.
18. Zhang Y, Hua Z, Yang K, et al. Outcomes of the rehabilitative procedure for patients with pulmonary atresia, ventricular septal defect and hypoplastic pulmonary arteries beyond the infant period. Eur J Cardiothorac Surg, 2014, 46(2): 297-303.
19. 鄭景浩, 徐志偉, 劉錦紛, 等. 肺動脈閉鎖合并室間隔缺損和 MAPCA 手術理念探討. 中華胸心血管外科雜志, 2014, 30(5): 257-260.0.
20. 周誠, 董念國, 杜心靈, 等. 姑息性手術在復雜先天性心臟病患者中的應用.中國胸心血管外科臨床雜志, 2012, 19(5): 494-497.0.

Previous Article
Analysis of 85 infants of minimal median sternotomy for cardiac surgery under cardiopulmonary bypass
Next Article
The influence of diabetes on aortic intramural hematoma recovery

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Right ventricle to pulmonary artery shunt as palliative operation for patients with severe cyanotic congenital heart disease

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content