完全性肺静脉异位引流的外科治疗体会

目的总结4例完全性肺静脉异位引流的治疗体会。方法4例患者均在中度低温体外循环下行手术治疗。3例心上型中,1例经房间沟行左心房后壁与肺静脉共干心外吻合,1例采用上腔静脉和升主动脉间行心外吻合,余1例采用经房间隔缺损吻合法。另1例混合型采用扩大房间隔缺损至冠状静脉窦,用心包片修补房缺,将肺静脉开口分隔至左心房侧。以上4例患者术中均同时结扎垂直静脉。结果术后早期死亡1例,余患者恢复顺利。术后随访7个月～5年,患者心功能恢复至Ⅰ～Ⅱ级,未见结性心律或Ⅲ度房室传导阻滞等心律失常。结论完全性肺静脉异位引流的患者应尽早手术治疗,其中心上型手术方法以经上腔静脉和升主动脉间行心外吻合较优越。

Experience of treatment for total anomalous pulmonary venous connection

Objective To review the experience of treatment of total anomalous pulmonary venous connection(TAPVC)in 4 patients.Methods All patients were repaired by using hypothermic cardiopulmonary bypass.The operations were performed via the atrioventricular groove approach,the top approach of left atrium and the atrium septal edfect approach in 3 cases of supracardiac type.1 case of mixed type was repaired by excision the roof of the coronary sinus and the resulting large defect closed with a pericardial patch.Results 1 patient died at early stage of postoperation.The others were followed-up 7 months to 5 years.All survivors have no arrhythmia and their heart functions were improved.Conclusion TAPVC should be taken surgical treatment as soon as possible.The top approach of left atrium is superior to other methods for supracardiac type repair.