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从格伦到方丹,从格伦到方丹. 一个持续的进化.

A R Castaneda1

  • 1Department of Surgery, Harvard Medical School, Boston, MA.

Circulation
|November 1, 1992
PubMed
概括
此摘要是机器生成的。

丰坦手术是复杂先天性心脏病的手术程序,已经有了显著的进化. 修改已经大大降低了外科手术死亡率和诸如肺流等并发症,改善了患者的治疗结果.

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科学领域:

  • 心血管外科心血管外科
  • 儿童心脏病学 儿童心脏病学
  • 遗传性心脏病是一种先天性心脏病.

背景情况:

  • 循环的历史理解从亚里士多德和盖伦发展到科伦坡和哈维.
  • 右心室的不可或缺性在20世纪受到挑战,导致了新的外科手术方法.
  • 1948年罗德巴德的实验绕过了狗的右心室,为格伦和丰坦手术铺平了道路.

研究的目的:

  • 审查对Fontan操作修改的临床经验.
  • 评估这些修改对手术结果和并发症的影响.

主要方法:

  • 该研究详细介绍了波士顿儿童医院的临床经验.
  • 修改包括直接的心房与肺动脉连接,洞穴混,双向洞穴肺动脉解剖,以及窗户式的Fontan方法.

主要成果:

  • 到1990-1991年,手术死亡率从20%降至4%,即使在复杂的病例中也是如此.
  • 延长性肺泄漏的发生率从双向腔肺动脉解剖学减少了40%至<5%,而窗口式方法减少了11%.

结论:

  • 自最初的Glenn和Fontan操作以来,已经取得了显著的进展.
  • 优化患者选择和进一步完善外科修改是改善早期和长期结果的关键.