婴幼儿肺静脉异位引流术后肺静脉狭窄的再干预治疗

Re-intervention of pulmonary vein stenosis after ectopic drainage of pulmonary vein in infants

目的分析婴幼儿肺静脉异位引流术后肺静脉狭窄(pulmonary vein stenosis,PVS)的原因,总结再干预治疗的经验。方法回顾性分析2012年5月至2019年12月郑州大学附属儿童医院胸心外科收治的13例肺静脉异位引流术后PVS患儿的临床资料。其中,男8例,女5例;年龄为(7.2±4.6)个月,范围在6~31个月;体重为(6.9±3.4)kg,范围在5.0~17.6 kg;完全性肺静脉异位引流(total anomalous pulmonary venous connection,TAPVC)术后12例,部分性肺静脉异位引流(partial anomalous pulmonary venous connection,PAPVC)术后1例。13例患儿再干预治疗前均给予心脏超声及心脏CT血管造影检查。其中,吻合口处狭窄7例,单支肺静脉狭窄4例(肺静脉于左房开口处狭窄2例,肺静脉远端狭窄1例,肺静脉近端狭窄1例),双支肺静脉狭窄(均为左侧)2例。9例采用Sutureless技术,3例采用牛心包补片扩大,1例球囊扩张后效果差后行牛心包补片扩大。结果13例患儿均顺利完成手术,住院期间死亡2例。其中,1例经体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)辅助治疗3 d后因颅内出血死亡;1例因原有脑部疾病,家属拒绝使用ECMO辅助治疗,后放弃治疗。另11例患儿随访3~36个月,无延迟死亡。1例采用的Sutureless技术和1例采用中心包补片扩大患儿术后随访3年,肺静脉流速为1.6~1.9 m/s,现随访观察中。结论儿童PVS多见于肺静脉畸形术后,尤其是TAPVC术后,应早期再干预治疗。Sutureless技术能明显改善PVS的预后。

Objective To explore the causes of pulmonary vein stenosis(PVS)after ectopic drainage of pulmonary vein in infants and to summarize the experience of reintervention.Methods From May 2012 to December 2019,13 hospitalized cases of PVS were recruited.There were total pulmonary venous ectopic drainage(n=12)and partial pulmonary venous ectopic drainage(n=1).There were 8 boys and 5 girls with an age range of(7.2±4.6)(6-31)months and a weight range of(6.9±3.4)(5.0-17.6)kg.Before re-intervention,echocardiography and cardiac computed tomography(CT)were performed to determine the type of PVRS.There were anastomotic stenosis(n=7)and single-branch pulmonary vein stenosis(n=4),including pulmonary vein stenosis at left atrial opening(n=2),distal pulmonary vein stenosis(n=1),proximal pulmonary vein stenosis(n=1)and double-branch pulmonary vein stenosis(n=2)(both left-sided).There were sutureless technique(n=9),bovine pericardial patch enlargement(n=1)and balloon expansion&bovine pericardial patching(n=1).Results All operations were successfully completed.Two cases died during hospitalization.One case died of intracranial hemorrhage after 3 days of ECMO-assisted treatment and another was abandoned by the family due to a refusal of ECMO-assisted treatment.Eleven children were followed up for 3-36 months without delayed death.One child underwent sutureless technique while another had bovine pericardial patch enlargement.Pulmonary venous velocity of two children were between 1.6-1.9 m/s after operation and follow-ups were conducted for 3 years.Conclusions PVS is quite common after operations for pulmonary venous malformation(esp.TAPVC)in infants.Early intervention is desired.And sutureless technique obviously improves the prognosis of PVS.