Warden系列手术在部分性肺静脉异位引流中的应用

The application of Warden series operation in partial anomalous pulmonary venous connection

目的明确Warden系列手术在部分性肺静脉异位引流(PAPVC)中应用的有效性和安全性。方法收集2016年1月—2018年3月天津市胸科医院心外科共诊治肺静脉引流至上腔静脉的PAPVC患者6例。全组患者皆行Warden系列手术,3例行Warden手术,3例行改良Warden手术,其中2例应用自体心包补片重建上腔-右房通道,1例运用Gor-Tax血管连接上腔静脉和右房。术后定期复查超声心动图和心电图(术后1个月、3个月、6个月、1年,超过1年每年复查1次),观察患者心脏结构变化、上腔静脉及肺静脉回流通畅情况及是否存在心律失常。结果全组患者术后顺利出院,随访3个月~2年,目前无死亡及再手术者。超声心动复查未见残余异常分流,且上腔静脉、肺静脉回流通畅。心电图提示皆为窦性心律,无明显异常。结论 Warden系列手术在部分性肺静脉异位引流中的应用安全有效,术后并发症少,值得推广。

Objective To clarify the efficacy and safety of Warden series operation in partial anomalous pulmonary venous connection(PAPVC).Methods Six patients with PAPVC(pulmonary vein drainage to superior vena cava),who were treated in cardiac surgery of Tianjin Chest Hospital from January 2016 to March 2018,were included in this study.All 6 patients underwent Warden series operation,including 3 with Warden surgery and another 3 with modified Warden surgery.Two patients underwent modified Warden surgery were rebuilt by autologous pericardial patch and 1 cases were connected to the superior vena cava and the right atrium with Gor-Tax vessels.The echocardiography and electrocardiogram were reviewed regularly after operation(1 month,3 months,6 months and 1 year after operation,1 time a year for more than 1 year after the operation).The changes of cardiac structure,superior vena cava and pulmonary venous reflux and arrhythmia were observed.Results All patients were discharged successfully.The patients were followed up for 3 months to 2 years.No residual anomalous shunt was found in reexaminating echocardiography,and superior vena cava and pulmonary venous return were unobstructed.Electrocardiogram showed sinus rhythm and no obvious abnormality.Conclusion The application of Warden series operation in partial anomalous pulmonary venous connection is safe and effective.