Prifti Edvin, Crucean Adrian, Bonacchi Massimo, Bernabei Massimo, Leacche Marzia, Murzi Bruno, Bartolozzi Fabio, Vanini Vittorio
Department of Pediatric Cardiac Surgery, G. Pasquinucci Hospital, Massa, Italy.
Eur J Cardiothorac Surg. 2003 Jul;24(1):21-7. doi: 10.1016/s1010-7940(03)00187-8.
The aim was to review our experience with the surgical repair of the anomalous origin of one pulmonary branch from the aorta (AOPA).
Between January 1991 and March 2002, eight patients with AOPA underwent surgical correction. Three patients presented isolated AOPA. Five patients presented right AOPA and three, left AOPA. Implantation of the AOPA to the main pulmonary artery was performed by: (I) direct anastomosis in two patients with left AOPA; (II) interposition of a synthetic graft in one patient with left AOPA; (III) employing an autologous pericardial patch in two patients with right AOPA; (IV) using an aortic flap in three other patients with right AOPA. The mean follow-up time was 37.7 months.
One patient died postoperatively due to progressive heart failure unresponsive to inotropic support. Early postoperative pulmonary hypertension crisis was identified in another patient. Within 1 year after surgery, the mean residual gradient across the anastomotic site at follow-up was 14+/-8 mmHg. The patient undergoing interposition of a synthetic graft presented a residual gradient of 29 mmHg and underwent reoperation at almost 2.5 years after the first correction. The residual gradient in patients undergoing correction according to technique I was 17+/-3 mmHg, and in patients undergoing implantation of the AOPA according to techniques III or IV was 9.5+/-4.6 mmHg (P=0.11). Similarly, the Tc-99m scintigraphy demonstrated that a lower lung perfusion (the lung perfused from the respective AOPA compared with the contralateral lung) in patients undergoing AOPA implantation according to technique I was 59+/-6(%) and in patients undergoing techniques III or IV was 72+/-4.5(%) (P=0.038). At follow-up, all patients were alive.
The AOPA from the aorta is a rare but important entity, necessitating a scrupulous preoperative and intraoperative evaluation. Patients presenting this anomaly may undergo correction using various surgical techniques with acceptable results. The techniques employing autologous tissues for enlarging and lengthening the AOPA seems to be associated with less restenosis at the anastomotic site, however, larger series of patients are required to confirm such outcome.
回顾我们对主动脉起源的一支肺动脉异常（AOPA）手术修复的经验。
1991年1月至2002年3月期间，8例AOPA患者接受了手术矫正。3例患者为孤立性AOPA。5例为右AOPA，3例为左AOPA。将AOPA植入主肺动脉的方法如下：（I）2例左AOPA患者采用直接吻合术；（II）1例左AOPA患者采用人工血管移植术；（III）2例右AOPA患者采用自体心包补片；（IV）另外3例右AOPA患者采用主动脉瓣片。平均随访时间为37.7个月。
1例患者术后因对强心支持无反应的进行性心力衰竭死亡。另1例患者术后出现早期肺动脉高压危象。术后1年内，随访时吻合口处的平均残余压差为14±8 mmHg。接受人工血管移植术的患者残余压差为29 mmHg，并在首次矫正后约2.5年接受了再次手术。采用技术I矫正的患者残余压差为17±3 mmHg，采用技术III或IV植入AOPA的患者残余压差为9.5±4.6 mmHg（P = 0.11）。同样，Tc-99m闪烁显像显示，采用技术I植入AOPA的患者肺灌注较低（与对侧肺相比，由相应AOPA供血的肺）为59±6（%），采用技术III或IV的患者为72±4.5（%）（P = 0.038）。随访时，所有患者均存活。
主动脉起源的AOPA是一种罕见但重要的疾病，术前和术中需要仔细评估。出现这种异常的患者可采用多种手术技术进行矫正，结果可接受。采用自体组织扩大和延长AOPA的技术似乎与吻合口处再狭窄较少有关，然而，需要更多患者的大样本研究来证实这一结果。
