完全性肺静脉畸形引流的外科治疗

SURGICAL CORRECTION OF TOTAL ANOMALOUS PULMONAYR VENOUS CONNECTION (TAPVC)

本院自1976年1月至1989年12月手术治疗完全性肺静脉畸形引流(TAPVC)58例。心上型38例,心内型19例,混合型1例。死亡5例,死亡率8.6%。本文对该病的发生率、诊断和手术方法进行讨论,着重介绍作者采用左右房联合切口矫治本病的经验。

Fifty-eight patients,30 males and 28 females with TAPVC, had been treated surgically from 1976 to 1989 in Fu Wai Hospital. Among them 38 cases (65.5%) were of supraeardiac type, 10 cases of cardiac type and 1 case of (1.7%) mixed type. Mean age at operation was 9.3±7.3 years(ranged 0.5 to 28 years).C/T varied from 0.49 to 0.77. Echocardiography was performed in 55 cases, 31 patients were diagnosed by cross-sectional echocardiography, 21 cases were misdiagnosed as ASD or other cardiac defect in the early period. Cardiac catheterization and angiography were performed in 47 patients. Pulmonary hypertension was found in 30 cases (76.6%) and 36 patients had arterial oxygen saturation less than 92%. Conventionalcardiopulmonary bypass with moderate hypothermia was employed for of the all pateints. Classical procedure was used in cardiac type correction. Anastomosis between common pulmonary venous trunk and left atrium was done in one of the following ways for supracardiac type:15 cases retrocardiacally, 14 cases through the atrial scptum, 6 cases with combined left and right incision, 1 case between aorta and SVC and 2 cases through ret- rocardiac plus atrial septal. The size of anastomosis varied from 2.0 to 3.0 cm in children and adults. The operative mortality was 8.6%(5/58). Anastomosis between common venous trunk and left atrium through combined left and right atrial incisions is thought to be the best approach. The size of anastmomosis should be adequate. Maintaining and improving left heart function is considered to be the key factor for the success of surgical correction of TAPVC.