Hickey Edward J, Caldarone Christopher A
Division of Cardiovascular Surgery and Labatt Family Heart Center, The Hospital for Sick Children, Toronto, Canada.
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2011;14(1):101-8. doi: 10.1053/j.pcsu.2011.01.007.
Obstructed pulmonary venous drainage - either in association with total anomalous pulmonary venous drainage, congenital stenosis, or post-repair stenosis - is associated with poor outcome. Post-repair stenosis typically involves fibrotic scar tissue extending from the site of anastomosis. "Sutureless" repair techniques avoid direct left atrial-pulmonary vein suture lines by instead reconstituting atrial tissue to posterior pericardium. Hence, the repair leaves widely decompressed pulmonary veins in the posterior mediastinum draining directly into the left atrium as a 'controlled bleed.' In our experience, late outcomes are significantly more favorable with sutureless repair techniques versus conventional pulmonary vein surgery. Therefore, after these encouraging results, we have now extended the application of this repair strategy to all scenarios of pulmonary vein surgery, including primary repair of unobstructed total anomalous pulmonary venous connection. The sutureless repair is versatile and facile. In particular, complex geometry of multiple decompressed veins can be easily accommodated by wide left atrial-pericardial suture lines. Common pitfalls can be avoided by mobilizing and protecting the phrenic pedicle and preserving the integrity of the areolar connective tissue and pleuro-parietal membrane. Overall, sutureless repair of anomalous or stenotic pulmonary veins appears safe and effective. Furthermore, in patients known to be at high risk of recurrent stenosis, sutureless techniques appear to offer improved freedom from recurrent stenosis.
肺静脉引流受阻——与完全性肺静脉异位引流、先天性狭窄或修复后狭窄相关——与不良预后相关。修复后狭窄通常涉及从吻合部位延伸的纤维化瘢痕组织。“无缝合”修复技术通过将心房组织重建至后心包来避免直接的左心房-肺静脉缝合线。因此，修复后后纵隔内的肺静脉广泛减压，直接作为“可控出血”引流至左心房。根据我们的经验，与传统肺静脉手术相比，无缝合修复技术的远期预后明显更好。因此，在取得这些令人鼓舞的结果后，我们现在已将这种修复策略的应用扩展到所有肺静脉手术场景，包括无梗阻性完全性肺静脉连接的一期修复。无缝合修复灵活且简便。特别是，宽的左心房-心包缝合线可以轻松适应多条减压静脉的复杂几何形状。通过游离和保护膈神经蒂以及保持乳晕结缔组织和胸膜-胸壁膜的完整性，可以避免常见的陷阱。总体而言，异常或狭窄肺静脉的无缝合修复似乎是安全有效的。此外，对于已知有复发性狭窄高风险的患者，无缝合技术似乎能提高免于复发性狭窄的几率。
