肺动脉内隧道术治疗婴幼儿左冠状动脉起源于肺动脉:超声心动图随访

Intrapulmonary tunnel procedure for repairing anomaly of left coronary artery originated from pulmonary artery in children:an echocardiographic follow-up

目的 探讨超声心动图评价肺动脉内隧道术治疗婴幼儿左冠状动脉起源肺动脉 (ALCAPA)疗效。方法 对 5例肺动脉内隧道术矫治ALCAPA患儿 ,于手术后出院前及门诊随访时行超声心动图检查。结果 全部患儿重建之左冠状动脉 /肺动脉内隧道通畅 ,左心室功能明显改善 ,射血分数显著增加 ,术后 2～ 3个月恢复正常。结论 肺动脉内隧道术可以显著改善ALCAPA患儿左心功能。超声心动图随访能够显示内隧道通畅情况、心功能恢复程度、并发症及术后残留异常。

Objective To evaluate the intrapulmonary tunnel procedure in children with anomaly of left coronary artery originated from pulmonary artery by follow up echocardiography. Methods Five children underwent intrapulmonary tunnel procedures in our hospital from August 1993 to April 2003, including one case with left ventricular aneurysmectomy concomitantly. Follow up echocardiography was performed at early postoperation and in 6 to 82 months after operation. Results In all of 5 children, intrapulmonary tunnels remained patent and left ventricular function improved to normal within 2 to 3 months postoperatively. Two children had moderate or severe mitral regurgitation remained. One child had significant supravalvular pulmonary stenosis. Two children had slight intrapulmonary tunnel leakage, which closed spontaneously during follow-up. Conclusion Intrapulmonary tunnel procedure is effective to rebuild a dual-coronary system and improve left ventricular function dramatically in these children. Echocardiography is valuable in the evaluation of therapeutic effect of intrapulmonary tunnel procedure. Possible complications, such as persisted mitral regurgitation, supravalvular pulmonary stenosis and intrapulmonary tunnel leakage, can be detected by follow-up echocardiography.