Jhang Won Kyoung, Park Jeong-Jun, Seo Dong-Man, Goo Hyun Woo, Gwak Mijeung
Division of Pediatric Cardiac Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Ann Thorac Surg. 2008 May;85(5):1753-8. doi: 10.1016/j.athoracsur.2008.01.059.
Patients with arch obstruction and intracardiac defects have a high probability of abnormal aortopulmonary space geometry, which provides airway compression. The tissue-to-tissue technique arch repair could result in real airway problems. This report describes our experience with the perioperative evaluation and management of airway problems.
We retrospectively reviewed the medical records of 90 patients with arch obstruction and intracardiac defects who underwent computed tomography (CT) and corrective surgery in our institution between January 2000 and January 2007.
Of the 77 patients who underwent preoperative CT (group 1), 21 were found to have airway compression (27.2%). Of those 21 patients, 5 underwent concomitant airway relieving procedures. In group 1, 2 patients required subsequent secondary surgery for airway problems after the initial arch repair. Of the 13 patients who underwent postoperative CT only (group 2), 6 underwent subsequent secondary surgery for airway relief. For airway relief, several procedures were additionally performed (eg, right pulmonary artery translocation anterior to the aorta, aortopexy, peribronchial dissection, and tissue augmentation). In terms of the type of arch repair, 48 patients underwent end-to-side anastomosis, 39 underwent extended end-to-end anastomosis, and 3 underwent end-to-end anastomosis. End-to-side was the repair type most commonly associated with airway compression requiring additional procedure (10 of 15, 66.6%).
Patients with arch obstruction and intracardiac defects had a rather high incidence of airway compression preoperatively and postoperatively. Preoperative CT and intraoperative complementary bronchoscopy were useful for identifying and fixing the airway problems. Additional procedures for relieving airway compression were required more frequently after end-to-side type arch repair than after extended end-to-end anastomosis. More meticulous intraoperative evaluation and management are recommended in this type of repair.
存在主动脉弓梗阻和心内缺损的患者，其主肺动脉间隙几何形态异常的可能性很高，这会导致气道受压。组织对组织技术的主动脉弓修复可能会引发实际的气道问题。本报告描述了我们在气道问题围手术期评估和管理方面的经验。
我们回顾性分析了2000年1月至2007年1月期间在我院接受计算机断层扫描（CT）及矫正手术的90例主动脉弓梗阻和心内缺损患者的病历。
在接受术前CT检查的77例患者（第1组）中，发现21例存在气道受压（27.2%）。在这21例患者中，5例同时接受了气道减压手术。在第1组中，2例患者在初次主动脉弓修复后因气道问题需要后续二次手术。在仅接受术后CT检查的13例患者（第2组）中，6例接受了后续的气道减压二次手术。为缓解气道压迫，还额外进行了几种手术（如右肺动脉移位至主动脉前方、主动脉固定术、支气管周围剥离术和组织增强术）。就主动脉弓修复类型而言：48例患者接受了端侧吻合术，39例接受了扩大端端吻合术，3例接受了端端吻合术。端侧吻合术是最常与需要额外手术缓解气道压迫相关的修复类型（15例中有10例，66.6%）
主动脉弓梗阻和心内缺损患者术前和术后气道受压的发生率相当高。术前CT和术中辅助支气管镜检查有助于识别和解决气道问题。与扩大端端吻合术相比，端侧型主动脉弓修复术后更频繁地需要额外的缓解气道压迫手术。对于此类修复，建议术中进行更细致的评估和管理。
