改良全腔静脉-肺动脉连接术治疗功能性单心室

目的 为了进一步改善全腔静脉－肺动脉连接手术的效果,探讨其经典手术方式的改良方法。方法 对１３例功能性单心室施行了改良全腔静脉－肺动脉妆手术 上腔静脉远心民右肺动脉上缘作端侧吻合,吻合口尽量偏左,近心端与右肺动脉下缘吻合,吻合口尽量偏右。其中５便在心脏不停跳下用Ｇｏｒｅ－Ｔｅｘ心外管道连接下腔静脉与右肺动脉下缘,８例采用心房内隧道。结果 术后早期死亡１例（７．７％）,１２例（９２．３％）存活者术后

Modified total cavopulmonary connection for treating patients with functional single ventricle

OBJECTIVE: To modify the classic procedure for better surgical results of total cavopulmonary connection (TCPC). METHODS: Modified TCPC was performed in 13 patients with functional single ventricle. In the modified TCPC procedure, the distal end of the superior vena cava (SVC) was connected with the upper edge of the right pulmonary artery (RPA) with the anastomosis orifice near the left side, and the proximal end with the lower edge of RPA with the anastomosis orifice near the right side. Among them, intra-atrial tunnel was established with a partial tube of PTFE using the lateral tunnel technique in 8 patients, and the distal end of the inferior vena cava (IVC) was directly connected with the lower edge of RPA using extracardiac conduit in the beating heart in 5. RESULTS: One patient (7.7%) died early. Twelve patients survived and had the SatO(2) (94.6 +/- 1.2)% postoperatively while inspiring air. Angiography showed that most blood from IVC enters the right lung and most blood from SVC the left lung. No late mortality was seen during the follow up for 6 months to 2 years and 2 months. NYHA class I was noted in 10 patients and class II in 2. Echocardiography showed that left ventricular volume reduced significantly and ventricular function was normal. CONCLUSIONS: Modified TCPC produces optimal blood flow between the two lungs, elevates postoperative Sat O(2) effectively, decreases ventricular volume load and improves ventricular functions.