完全性肺静脉异位引流的外科治疗及疗效

１９８８年１１月至１９９５年１２月外科治疗１１例完全性肺静脉异位引流（ＴＡＰＶＣ）病人，其中心上型７例，心内型４例。术后死亡１例。术后１０例生存者心功能较术前明显恢复，无远期吻合口狭窄和肺静脉梗阻发生。ＵＣＧ检查发现右房、右室内径较术前明显缩小（Ｐ≤０．０００１），左室舒张末期内径明显增大（Ｐ＜０．００２），心脏指数和射血分数较术前明显提高（Ｐ＜０．０００１）；左房内径略有增大但无统计学意义，共同肺静脉干术后无明显变化。结论：ＴＡＰＶＣ外科治疗成功的关键取决于术前左心室发育及其顺应性；手术吻合口通畅和无远期吻合口狭窄或肺静脉梗阻

Surgical Treatment for Anomalous Pulmonary Venous Connection and Its Late Results

Aim:The aim of this study was to review the experience of surgical treatment for total anomalous pulmonary venous connection(TAPVC)and its late results.Clinical material and method:From November 1988 to December 1995,11 patients with TAPVC underwent surgical correction under cardiopulmonary bypass.There were 3 males and 8 females with a mean age of 11.3 years.7 patients(63.6%)were supracardiac type and 4(36.4%)were intracardiac type.Results:There were one operative death giving a hospital mortality of 9.1%.The cause of death was anastomotic twist.Ten patients survived and their heart function improved significantly.In 10 survivors,there was a markedly decrease of right atrial end diastolic diameter and right ventricular end diastolic diameter(P<0.001),markedly elevation of left ventricular end diastolic diameter(P<0.002),and markedly increase of cardiac index and left ventricular ejection fraction(P<0.001).Conclusion:The surgical outcome is directly related to the following factors:compliance of the left ventricule before surgery,patency of anastomosis between CPVS and left atrium,and no anastomotic stenosis or obstruction of pulmonary vein.