心上径路治疗新生儿和小婴儿完全性心上型肺静脉异位引流

Superior approach for correction of supracardiac total anomalous pulmonary venous connection in neo nates and infants

目的探讨心上径路治疗新生儿和小婴儿完全性心上型肺静脉异位引流（total anomalous pulmonary venous connection，TAPVC）的临床效果。方法2006年6月至2009年6月，采用心上径路矫治新生儿和小婴Jb6上型TAPVC26例，其中男17例，女9例。年龄18d～8个月，平均（4．2±2．8）个月。体重3．4～8．1kg，平均（5．8±2．1）kg。全部患儿经心上径路完成矫治手术。总转流时间49-98min，平均（68．7±15．3）min；主动脉阻断时间31～77min，平均（47．6±14．7）min。结果术后早期无死亡；交界区心律或心律紊乱5例（19．1％）；中期随访23例，时间5个月～3年，平均18个月，无死亡。心功能Ⅰ级21例，Ⅱ级2例，全部为窦性心律；复查超声心动图示吻合口通畅22例，轻度狭窄1例。结论采用心上径路治疗新生儿和小婴儿完全性心上型肺静脉异位引流临床效果满意。

Objective To evaluate the short term outcome of surgical treatment of supracardiac total anomalous pulmonary venous connection （TAPVC） via superior approach in neonates and infants. Methods From June 2006 to June 2009, 26 patients with supracardiac TAPVC underwent surgical repair through superior approach. There were 17 males and 9 females. Their ages ranged from 18 days to 8 months old （mean, 4. 2 ± 2. 8 years）. The weight ranged from 3.4 to 8. 1 kg （mean, 5.8 ± 2. 1 kg）. Before surgery, all patients had apnea and cyanosis at resting state, and their resting SpO2 ranged from 65 % to 85%. The heart/chest ratio calculated on X-ray film was from 0. 62 to 0. 77. Electrocardiograph （ECG） of the patients showed sinus rhythm, right atrium enlargement and right ventricle hypertrophy. Echocardiography revealed moderate to severe pulmonary hypertension and various degree of tricuspid reflux. Under general anesthesia and cardiopulmonary bypass, direct anastomosis between the top of the left atrium and the common pulmonary venous trunk were performed via superior approach. Results The cardiopulmonary bypass time was 68. 7 ± 15.3 min and the aortic cross-clamping time was 47. 6 ± 14. 7 min. The patients were followed up for 5 months to 3 years （mean, 18 months）. No death after surgery was noted. Five patients had atrial arrhythmia （19. 1 %） in the early postoperative stage. One patient had mild anastomotic stenosis. Two neonates had delayed sternum closure. Two patients had diaphragm paralysis, one of which underwent diaphragm placation. All of the patients except 2 had satisfactory cardiac function. Conclusions Correction of supracardiac total anomalous pulmonary venous connection via superior approach is safe and effective in neonates and infarcts.