左上腔静脉左心房异位引流的外科矫治

Surgical repair for anomalous drainage of left superior vena cava to left atrium

目的:讨论左上腔静脉左心房异位引流的病变特点及其外科治疗方法。方法:回顾性分析和总结2005年5月至2008年12月中南大学湘雅二医院小儿心脏外科8例左上腔静脉左心房异位引流患儿的临床资料,年龄6～168(54.6±55.1)月;体质量6～29(13.1±7.7)kg。结果:8例患儿均合并有心内畸形,其中部分型房室间隔缺损4例,包括冠状静脉窦口闭锁1例;室间隔缺损、室间隔缺损合并右室流出道梗阻、完全性房室间隔缺损和房间隔缺损各1例。术前确诊者1例,术中确诊者5例,术后2例因顽固性低氧血症再次手术而确诊。3例采用心房内转流,5例采取心外管道分流手术,无死亡病例。结论:左上腔静脉左心房异位引流术前容易漏诊,提高认识和术中仔细探查可提高诊断率。异位引流的左上腔静脉处理方法取决于发现的时间和手术医生的个人经验。

Objective To investigate the characters and surgical treatment methods of anomalous drainage of left superior vena cava to left atrium.Methods Clinical data of 8 cases were analyzed retrospectively.The patients aged from 6 months to 168 months with weight between 6 and 29 kg.Results The associated cardic lesions existed in all patients：4 had partial atrioventricular septal defect （PAVSD）,including 1 coronary sinus orifice atresia （CSOA）,1 ventricle septal defect （VSD）,1 ventricle septal defect associated with right ventricular outlet tract stenosis （VSD/RVOTS）,and 1 atrial septal defect （ASD） and complete atrioventricular septal defect （CAVSD）,respectively.No patient died.Preoperation diagnosis was in 1case,intraoperation diagnosis in 5 cases,and postoperation diagnosis in 2 cases due to reoperation for hypoxemia.Three patients were repaired by intratrium tunnel,and the other 5 were managed by extracardic shunt.Conclusion This lesion is easily missed in preoperation diagnosis,which can be avoided by awareness and careful inspection.The methods for management of anomalous drainage of left superior vena cava to left atrium depend on time of diagnosis and experience of surgeons.