ID 110456
タイトルヨミ
シンカ スル ウシン バイパス ジュンカン
タイトル別表記
Evolving Fontan circulation
著者
北川, 哲也 徳島大学医学部附属病院心臓血管外科 徳島大学 教育研究者総覧 KAKEN研究者をさがす
北市, 隆 徳島大学医学部附属病院心臓血管外科 徳島大学 教育研究者総覧 KAKEN研究者をさがす
筑後, 文雄 徳島大学医学部附属病院心臓血管外科
川人, 智久 徳島大学医学部附属病院心臓血管外科
キーワード
Norwood palliative surgery
pulmonary blood flow
staged Fontan strategy
ventricular geometry
normal oxygen saturation
資料タイプ
学術雑誌論文
抄録
Since Fontan’s exploit over 30 years ago, a number of important advances relevant tothe Fontan strategy could be achieved as being variations in the technique of anatomical connectionof the systemic venous circulation to the pulmonary arteries and variations instaging of the Fontan procedure. Innovative Norwood procedure and its concept as a firststage of palliation to Fontan circulation have been equivalent to Fontan’s exploit, and haveproduced the “current” philosophy of pushing patients into Fontan physiology early in lifewith hemi-Fontan procedure or bidirectional Glenn shunt.The aim of the first half of our present study is to determine the optimal size and techniquefor construction of the systemic-to-pulmonary arterial shunt which will provide suitablepulmonary blood flow in first-stage Norwood palliation for hypoplastic left heart syndromein neonates. A prosthesis of 3.0 or 3.5 mm in diameter arising from the brachiocephalicartery would be acceptable and can be recommended for first-stage Norwood palliation insmall infants. Although many complicated factors are concerned in the regulation of pulmonaryblood flow, the fundamental strategy is to create a necessary and minimal systemicto-pulmonary arterial shunt in the first-stage Norwood palliation, and then to proceed swiftlywith a second-stage hemi-Fontan procedure.It remains to be determined whether all children should undergo an intermediate hemi-Fontan procedure or bidirectional Glenn shunt prior to their Fontan completion. In my personalopinion, the several advantages of the hemi-Fontan procedure seem to be weighed againstits disadvantages. It is our current practice to perform an intermediate hemi-Fontanprocedure in staging of the Fontan strategy of the patients with some risk factors. Althoughwe generally have waited 6-8 months after a hemi-Fontan operation for a Fontancompletion, we would like to perform an early Fontan completion a few months after hemi-Fontan procedure to shorten the period of partial Fontan circulation and get nearly normaloxygen saturation. Careful follow-up and further investigation will be necessary to determinethe most optimal management guidelines for the Fontan circulation.
掲載誌名
四国医学雑誌
ISSN
00373699
cat書誌ID
AN00102041
出版者
徳島医学会
56
4
開始ページ
136
終了ページ
144
並び順
136
発行日
2000-08-25
EDB ID
フルテキストファイル
言語
jpn
著者版フラグ
出版社版
部局
医学系