心脏右侧径路纠治心下型肺静脉异位回流

A modification of surgical procedure for infracardiac total anomalous pulmonary venous connection

目的 评估经心脏右侧径路纠治心下型完全性肺静脉异位回流方法的价值.方法 2005年9月至2007年12月,采用经心脏右侧进路方法纠治心下型完全性肺静脉异位回流7例.平均年龄（70.57 -44.67）天;平均体重（4.07±0.87）kg.其中3例肺静脉回流梗阻,2例卵圆孔未闭较小.结果 无手术死亡.术后并发症包括：低心排5例,发生肺动脉高压危象3例,呼吸机辅助7天以上2例,肺部感染2例.术后随访6个月至2年,超声检查心房内无残余分流,吻合口无明显梗阻,流速1.20～1.47m/s;心功能：射血分数0.70～0.79,短轴缩短率0.32～0.44;1例出现肺静脉回流的流速增快,其右上肺静脉2.60m/s,右下肺静脉2.12m/s,继续随访中.结论 采用经心脏右侧径路方法纠治心下型完全性肺静脉异位回流,取得了较好效果.手术成功取决于左房与垂直静脉的吻合口大小,保证肺静脉回流无梗阻.

Objective Infracardiac total anomalous pulmonary venous connection, a rare congenital cardiac defect, is associated with high mortality. A modification was designed for the procedure to reduce the post-operative obstruction in the pulmonary venous. Methods From September 2005 to December 2007, seven patients with infracardiac total anomalous pulmonary venous connection were treated with repair surgery through right side approach. The patients＇ age at operation was （70.57 ±44.67） days , the weight was （4.07 ±0.87） kg. Three patients had pulmonary venous obstruction, and 2 with small PFO. A modified right - side approach for repairing this defect was used. Results No death occurred after the operation. The postoperative complications included low cardiac output in 5 patients （71.43%）, pulmonary hypertension crisis in 3patients （ 42.86% ） , mechanical ventilation for more than 7 days, which happened in 2 patients （28.58%） and pulmonary infection. All of the patients received follow-up. No residual shunt and pulmonary venous return obstruction were identified on echocardiogram（with a velocity from 1.2 m/s to 1.47 m/s）. The heart function of patients was within the normal range（EF 0.70 -0.79, FS 0.32 -0.44）. Conclusion The modified surgical procedure for the correction of infracardiac total anomalous pulmonary venous connection by right side approach was associated with favorite clinical outcomes, The post-operative outcomes depended on the size of anastomosis between the common vein and left atrium and the patency of the pulmonary venous return. Adequate size of anastomosis and maintenance of the spatial structures in adjacent regions were helpful in decreasing the adverse effect of postoperative obstruction.