Myocardial ischemia risk in Fontan candidates with pulmonary atresia with intact ventricular septum.

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

General Thoracic and Cardiovascular Surgery Pub Date : 2025-03-03 DOI:10.1007/s11748-025-02131-4

Naoki Masaki, Hideki Tatewaki, Satoshi Matsuo, Masaru Kumae, Kohei Yagi, Takehiko Onoki, Eiichiro Kawai, Megumi Nitta, Akira Ozawa, Sadahiro Sai

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引用次数: 0

Abstract

Objectives: Sinusoidal communication (SC) is prevalent among Fontan candidates with pulmonary atresia with intact ventricular septum (PA/IVS), making it crucial in understanding its dynamics and potential impact on myocardial perfusion. This study aimed to assess the risk of myocardial ischemia in these patients.

Methods: Sixteen Fontan candidates with PA/IVS were included in this study. All patients initially underwent Blalock-Taussig shunt (BTS), followed by bidirectional Glenn shunt in 15 cases, culminating in a total cavopulmonary connection (TCPC) at a median age of 24 months. SC severity and risk of myocardial ischemia were assessed via angiography and scintigraphy, respectively. Changes in SCs across the procedural stages and their correlation with ischemic responses in scintigraphy were retrospectively analyzed.

Results: No deaths occurred during the study period. Ischemic events were observed in only one patient. SCs were observed in all 16 patients (100%). Significant regression of SCs occurred after BTS, particularly in coronary arteries with major SCs. However, no significant changes were found thereafter, particularly among coronary arteries without major SCs. No improvement or exacerbation of ischemic lesions was observed from pre- to post-TCPC. A positive correlation was revealed between angiographic SC grade and positive ischemic response on scintigraphy.

Conclusions: In Fontan candidates with PA/IVS, an SC grade of 2 or higher was associated with a high risk of myocardial ischemia, emphasizing the need for careful monitoring and clinical management.

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肺闭锁室间隔完整的Fontan候选患者的心肌缺血风险。

目的：Sinusoidal communication （SC）在肺闭锁伴完整室间隔（PA/IVS）的Fontan候选患者中普遍存在，因此了解其动态及其对心肌灌注的潜在影响至关重要。本研究旨在评估这些患者发生心肌缺血的风险。方法：选取16例PA/IVS方丹候选患者。所有患者最初都接受了blallock - taussig分流术（BTS），随后15例进行了双向Glenn分流术，最终在中位年龄24个月时进行了全腔隙肺连接（TCPC）。分别通过血管造影和闪烁造影评估SC的严重程度和心肌缺血的风险。回顾性分析了sc在整个过程阶段的变化及其与脑缺血反应的相关性。结果：研究期间无死亡病例发生。仅1例患者出现缺血事件。所有16例患者（100%）均观察到SCs。BTS后，特别是在有主要sc的冠状动脉中，sc明显减少。然而，此后没有发现明显的变化，特别是在没有主要sc的冠状动脉中。从tcpc之前到之后，没有观察到缺血性病变的改善或恶化。血管造影SC分级与血管造影阳性缺血反应呈正相关。结论：在PA/IVS的Fontan候选患者中，2级或更高的SC级与心肌缺血的高风险相关，强调需要仔细监测和临床管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

General Thoracic and Cardiovascular Surgery Medicine-Pulmonary and Respiratory Medicine

CiteScore

2.70

自引率

8.30%

发文量

142

期刊介绍： The General Thoracic and Cardiovascular Surgery is the official publication of The Japanese Association for Thoracic Surgery and The Japanese Association for Chest Surgery, the affiliated journal of The Japanese Society for Cardiovascular Surgery, that publishes clinical and experimental studies in fields related to thoracic and cardiovascular surgery.