4歳未満の患者における修正フォントン処置
J M Pearl1, H Laks, D C Drinkwater
1Department of Surgery, University of California, Los Angeles Medical School.
Circulation
|November 1, 1992
まとめ
修正されたFontan手順は,4歳未満の子供にとって安全で有効であり,改善された臨床結果を提供します. 選択された患者に対する早期の介入は,肺血管床を保護し,心室機能を保ちます.
科学分野:
- ペディアトリック・カルディオロジー
- 生まれながらの心臓手術 生まれながらの心臓手術
- 小児心臓病重症室のケアについて
背景:
- 小児 (4歳未満) に施された修正されたフォンタン処置は,当初,異なった成功率と高い死亡率を示した.
- 最近の進歩は,若い小児科の集団において,修正されたフォンタン処置のアウトカムを改善しました.
- 早期のフォンタン緩和は,肺血管床の保護と心室機能の保存などの利点を提供します.
研究 の 目的:
- 4歳未満の患者で修正されたフォンタン手法の安全性と有効性を評価する.
- この小児科コホートにおける早期と後期の結果を比較するために.
主な方法:
- 1982年~1991年5月間,修正されたフォンタン手術を受けた4歳未満の90人の患者を遡及的にレビューした.
- 患者さんの診断には,三管縮症,単一心室縮症,肺縮症,左心筋プラスティック症候群が含まれていました.
- 調整性心房閉口術 (ASD) は21例で使用されました.
主要な成果:
- 早期死亡率は8.9% (8/90) であり,フォントンの全体的な早期死亡率は7.4%であった.
- 2歳未満の患者 (n=30) の場合,早期死亡率は6.7% (2/30) であった.
- 38ヶ月の平均フォローアップでは,3人の遅い死亡 (3.7%) と1人の心臓移植が報告されました.
結論:
- 修正されたFontan手順は,4歳未満の患者に安全に実施でき,良好な臨床結果が得られます.
- 早期のフォンタン緩和は,進行性シアノシスと好ましい血液動力学を持つ6ヶ月以上の乳児に推奨されます.
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