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    緩解性心臟外科手術 Palliative procedure of congenital heart disease

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    先天性心臟病 心臟科 梅世穎醫師投稿筆記
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      TinyNotes last edited by TinyNotes

      投稿人:梅世穎醫師

      alt text
      (正常的循環)

      BT shunt: Blalock-Taussig's shunt

      (1) 適應症

      • 肺部血流量不足的患者,大多用在發紺性先天性心臟病

      (2) 手術後解剖

      • 主動脈(Aorta)分枝連接到肺動脈(pulmonary artery),一般來說會選無名動脈(innominate artery、或名頭臂動脈幹Brachiocephalic trunk)或是鎖骨下動脈(subclavian artery)來直接連接到同側的肺動脈(pulmonary artery)

      (3) 手術併發症

      • 術側手臂發育不良或是有缺血性變化、術側膈神經(phrenic nerve)受損

      alt text

      Modified BT shunt: Modified Blalock-Taussig's shunt

      (1) 適應症

      • 肺部血流量不足的患者,大多用在發紺性先天性心臟病

      (2) 手術後解剖

      • 從主動脈(Aorta)分枝接人工血管到肺動脈(pulmonary artery),連結位置會從鎖骨下動脈(subclavian artery)來連接到同側的肺動脈(pulmonary artery)

      (3) 手術併發症

      • 術側膈神經(phrenic nerve)受損

      ![alt text](image url

      Central shunt: Mee's shunt

      (1) 適應症

      • 肺部血流量不足的患者,大多用在發紺性先天性心臟病以及BT shunt失去功用的患者

      (2) 手術後解剖

      • 主動脈(Aorta)直接連接人工血管到肺動脈 (pulmonary artery) 主幹,或是選用內乳動脈(internal mammary artery)來直接連接到肺動脈 (pulmonary artery) 主幹

      (3) 手術併發症

      • 術側手臂發育不良或是有缺血性變化、術側膈神經(phrenic nerve)受損

      alt text

      Glenn shunt: hemi-Fontan shunt

      (1) 適應症

      • 肺部血流量不足的患者,大多用在發紺性先天性心臟病以及BT shunt、Central shunt失去功用(或說不足以供應患者充氧血)的患者

      (2) 手術後解剖:

      • 傳統型
        將上腔大靜脈(superior vena cava)接到右側肺動脈(right pulmonary artery)並截斷右側肺動脈(right pulmonary artery)和肺動脈(pulmonary artery)主幹的相接
        alt text

      • 雙向型
        將上腔大靜脈(superior vena cava)接到右側肺動脈(right pulmonary artery)和肺動脈(pulmonary artery)主幹之間

      alt text

      (3) 名稱來源

      • 又稱為Hemi-Fotan 的原因在於Fontan就是將上下腔大靜脈(superior and inferior vena cava)連到肺動脈(pulmonary artery),只連接上腔大靜脈(superior vena cava)到肺動脈(pulmonary artery)就是只做一半的Fontan procedure

      (4) 手術併發症:上腔大靜脈血栓、中風、心律不整、上肢水腫

      Reference:

      1. Palliative procedures for congenital heart defects, Shi-MinYuan, HuaJing
      2. Khonsari';s Cardiac Surgery Safeguards and Pitfalls in Operative Technique 5 edition

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