心内型完全性肺静脉异位引流的解剖特征及手术矫治

Anatomic features and surgical repair of cardiac total anomalous pulmonary venous connection

目的分析心内型完全性肺静脉异位引流（TAPVC）的解剖特征及手术矫治对策。方法1981年4月-2006年12月手术治疗心内型TAPVC25例（男17例，女8例），年龄26d～14岁，平均（2．56±3．56）岁；体重3．3～21．0kg，平均（6．85±10．06）kg。依据Darling分型，分为ⅡA及ⅡB两个亚型。所有患儿行超声心动图及心导管检查确诊，均在全麻低温体外循环下行矫治术。结果所有患儿治愈出院。主要并发症为低心排出量综合征、肺水肿2例。随访3个月～26年，心功能均达到Ⅰ级，无肺静脉回流梗阻发生。结论心内型TAPVC确诊后宜尽早手术，成功的关键在于术前、术中对其解剖特征准确判定及合适的心房分隔。

Objective To investigate the anatomic features and surgical repair of cardiac total anomalous pulmonary venous connection （TAPVC）. Methods Twenty-five patients underwent cardiac TAPVC repair between April 1981 and December 2006. Seventeen were males and 8 were females. The operative age ranged from 26 days to 14 years, mean （2.56 ± 3. 56） years. The weight ranged from 3. 3 kg to 21.0 kg,mean（6. 85 ± 10. 06）kg. According to Darling method, 25 cases were divided into two subgroups （ⅡA and ⅡB）. Diagnosis was made in all cases by echocardiography and cardiac catheterization preoperatively. All the patients underwent total correction under cardiopulmonary bypass. Results There was no hospital mortality. The main postoperative complications were low cardiac output syndrome and pulmonary edema in two cases. All patients were followed-up with a range of 3 months to 26 years. Heart function of all patients was grade L There was no postoperative pulmonary venous obstruction in these groups. Conclusions The surgical repair should be performed once the diagnosis is made. It is crucial to accurately understand the anatomic features and determine a suitable septum before operation.