摘要
目的探讨类右室功能重建Fontan术(MFRVF)术后中期随访的血流模式特征。方法选取2013年1月至2016年6月北部战区总医院收治的6例行MFRVF患者,男性3例,女性3例,年龄6.5(2.0,12.0)岁,年龄范围为2~17岁,随访(10.3±0.9)年。分析患者末次随访超声心动图(观察患者吻合口大小、各吻合口血流流速、心室收缩功能)、CT三维重建(观察患者手术植入Y型外管道情况)、核素肺血流灌注(观察患者优势肺灌注及左、右肺血流比例)、心脏核磁4D-Flow(观察患者手术植入Y型外管道与心动周期的变化以及各管腔内血流耗能、侧壁压力)检查资料。结果超声心动图显示吻合口大小、流速满意。CT三维重建显示外管道形态良好,无受压、扭曲。核素肺血流灌注显示右肺优势灌注,左、右肺血流比例基本达1∶1的生理状态。心脏核磁4D-Flow可见外管道随着心动周期而出现类右心室功能作用,下腔静脉至左、右肺血较均衡。结论MFRVF中期血流模式特征为血流动力学呈现稳定的Fontan循环,心室功能良好,优化肺循环状态。
Objective To evaluate the hemodynamic characteristics of modified Fontan procedure incorporating right ventricular functional restoration(MFRVF)during mid-term follow-up.Methods A total of 6 patients who underwent MFRVF at General Hospital of Northern Theater Command from January 2013 to June 2016 were enrolled,including 3 males and 3 females,aged 6.5(2.0,12.0)years old,ranging from 2 to 17 years old.All patients completed follow-up for(10.3±0.9)years.Analyze the patient's last follow-up echocardiography(to observe the anastomosis diameter,flow velocity at each anastomosis,and ventricular systolic function),CT 3D reconstruction(morphological evaluation of surgically implanted Y-shaped extracardiac conduit),radionuclide pulmonary perfusion(to observe the dominant lung perfusion and left/right pulmonary blood flow ratio),and cardiac MRI 4D-Flow(to observe dynamic changes of Y-shaped conduit during cardiac cycle,energy loss in luminal flow,and lateral wall pressure).Results Echocardiography demonstrated satisfactory anastomotic dimensions and flow velocities.CT 3D reconstruction confirmed optimal conduit morphology without compression or torsion.Pulmonary perfusion scintigraphy revealed right lung-dominant perfusion and the left/right pulmonary blood flow ratio basically reached 1∶1 with near-physiological state.Cardiac MRI 4D-Flow showed conduit-generated“functional right ventricle”effects during cardiac cycle,with balanced inferior vena cava-to-pulmonary artery flow distribution.Conclusion MFRVF achieves stable Fontan circulation dynamics in mid-term follow-up,characterized by preserved ventricular function and optimized pulmonary hemodynamics.
作者
张春振
尹宗涛
方敏华
杨本强
孙玉
张旭
张永
王辉山
ZHANG Chun-zhen;YIN Zong-tao;FANG Min-hua;YANG Ben-qiang;SUN Yu;ZHANG Xu;ZHANG Yong;WANG Hui-shan(Department of Cardiovascular Surgery,General Hospital of Northern Theater Command,Shenyang 100016,China)
出处
《创伤与急危重病医学》
2025年第3期161-163,共3页
Trauma and Critical Care Medicine
