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 , 张向立 ¹ , 杨慧娟 ¹ , 刘洋 ¹ , 朱勇峰 ¹ , 杨恒 ¹ , 郭琳 ²

1. ;
2. ;

Corresponding author：

浮志坤, Email: fuzhikun@126.com

Keywords：

姑息手术; 右室-肺动脉连接术; 先天性心脏病

DOI：

10.7507/1007-4848.201606026

Video：

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目的探讨姑息性右室-肺动脉连接术在重症紫绀型先天性心脏病治疗中的临床应用。方法回顾性分析郑州市第七人民医院心脏外科 2011 年 1 月至 2015 年 1 月期间所有行姑息性右室-肺动脉连接术治疗的重症紫绀型先天性心脏病患者 25 例的临床资料，其中男 17 例、女 8 例，年龄 31（5～108）个月，体重 3.5～37.2（12.82±6.73）kg。结果 25 例姑息性右室-肺动脉连接术后早期死亡 2 例（术后 30 d 内），早期死亡率 8.0%（2/25）。患者术后动脉血氧饱和度与术前差异有统计学意义（62.43%±7.83%vs. 81.62%±6.25%，P<0.05）。术后随访 6 个月至 3 年（每 3 个月复查一次超声心动图），23 例患者 McGoon 比值（1.05±0.14vs. 1.61±0.18，P<0.05）和 Nakata 指数[（112.37±14.38）mm²/m² vs. （165.74±22.62） mm²/m²，P<0.05]均明显上升，且差异有统计学意义。17 例患者行二期根治手术治疗。结论姑息性右室-肺动脉连接术能够有效促进重症紫绀型先天性心脏病患者的自身肺血管床发育，为行二期根治术创造条件。

Citation： 浮志坤, 张向立, 杨慧娟, 刘洋, 朱勇峰, 杨恒, 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.	徐朝军, 宋岚, 尹晓清, 等. 改良 B-T 分流术在肺血减少型先天性心脏病中的临床应用. 中国胸心血管外科临床杂志, 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.	鲁中原, 李守军, 王旭, 等. 体-肺动脉分流与右室肺动脉连接术治疗肺动脉闭锁合并室间隔缺损术后早期疗效的对比研究. 中国胸心血管外科临床杂志, 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.	张浩, 王德, 花中东, 等. 姑息性右心室肺动脉连接术在肺动脉闭锁合并室间隔缺损治疗中的应用. 中国胸心血管外科临床杂志, 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.	邓喜成, 沈向东, 郭少先, 等. 姑息手术在肺动脉闭锁合并室间隔缺损分期矫治中的应用. 中国胸心血管外科临床杂志, 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.	刘锦纷, 陈会文, 苏肇伉, 等. Gore-tex 管重建前向性肺循环姑息性治疗法洛氏四联症合并肺动脉闭锁. 中华胸心血管外科杂志, 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.	郑景浩, 徐志伟, 刘锦纷, 等. 肺动脉闭锁合并室间隔缺损和 MAPCA 手术理念探讨. 中华胸心血管外科杂志, 2014, 30(5): 257-260.0.
20.	周诚, 董念国, 杜心灵, 等. 姑息性手术在复杂先天性心脏病患者中的应用.中国胸心血管外科临床杂志, 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. 徐朝军, 宋岚, 尹晓清, 等. 改良 B-T 分流术在肺血减少型先天性心脏病中的临床应用. 中国胸心血管外科临床杂志, 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. 鲁中原, 李守军, 王旭, 等. 体-肺动脉分流与右室肺动脉连接术治疗肺动脉闭锁合并室间隔缺损术后早期疗效的对比研究. 中国胸心血管外科临床杂志, 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. 张浩, 王德, 花中东, 等. 姑息性右心室肺动脉连接术在肺动脉闭锁合并室间隔缺损治疗中的应用. 中国胸心血管外科临床杂志, 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. 邓喜成, 沈向东, 郭少先, 等. 姑息手术在肺动脉闭锁合并室间隔缺损分期矫治中的应用. 中国胸心血管外科临床杂志, 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. 刘锦纷, 陈会文, 苏肇伉, 等. Gore-tex 管重建前向性肺循环姑息性治疗法洛氏四联症合并肺动脉闭锁. 中华胸心血管外科杂志, 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. 郑景浩, 徐志伟, 刘锦纷, 等. 肺动脉闭锁合并室间隔缺损和 MAPCA 手术理念探讨. 中华胸心血管外科杂志, 2014, 30(5): 257-260.0.
20. 周诚, 董念国, 杜心灵, 等. 姑息性手术在复杂先天性心脏病患者中的应用.中国胸心血管外科临床杂志, 2012, 19(5): 494-497.0.

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

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