在全腔肺连接患者中定义Fontan循环衰竭的原因
Joeri Van Puyvelde1,2, Filip Rega1,2, Werner Budts2,3
1Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.
Interdisciplinary cardiovascular and thoracic surgery
|November 20, 2024
概括
以死亡率或严重症状来定义的Fontan衰竭发生在约10%的患者中,发生在全腔肺连接后的15年内. 右心室的优势导致了收缩功能障碍,而左心室的优势导致了限制性病理生理学或高肺血管抵抗.
科学领域:
- 心脏病学 心脏病学
- 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:
- 芬坦手术是复杂的单心室先天性心脏缺陷的缓解手术.
- 在全腔肺连接 (TCPC) 后的长期结果和失败原因需要持续调查.
研究的目的:
- 识别和分析在全腔肺连接后导致Fontan失败的因素.
- 根据心室优势区分失败机制.
主要方法:
- 在1988年至2023年期间接受TCPC治疗的217名患者的回顾性审查.
- 分析Fontan衰竭的原因,包括死亡率,心脏移植和功能衰退.
- 结果的分层基于右与左心室主导形态.
主要成果:
- 在24名患者 (11.1%) 中发生了Fontan失败,在20年后,无失败率为77.2%.
- 系统性心室功能障碍是最常见的失败原因 (29%),特别是在右心室主导患者中.
- 在左心室主导患者中,限制性病理生理学和高肺血管抵抗性是常见的.
结论:
- 大约10%的患者在TCPC后15年内经历Fontan衰竭.
- 心室主导决定了Fontan衰竭的主要机制:RV主导的缩功能障碍,LV主导的限制性病理生理学/高PVR.
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