Kuwabara M, Onitsuka T, Yonezawa T, Nakamura K, Fukushima Y, Araki K, Uchimura Y, Oshikawa M, Shibata K, Koga Y
Second Department of Surgery, Miyazaki Medical School.
Kyobu Geka. 1990 Dec;43(13):1071-5.
An eleven-day-old newborn with cyanosis and respiratory distress was admitted. Intubation and catecholamine administration had already done. Blood pressure was 80/50 mmHg, heart rate was 160/min. Urine volume was only 7 ml per 4 hours with diuretics. The diagnosis of supracardiac type of TAPVD was done by echo cardiography. Without cardiac catheterization, emergent operation was performed. After median sternotomy, the mobilization of the aorta was done. Under cardiopulmonary bypass the aorta was retracted to the left, the superior vena cava to the right and the common pulmonary venous trunk (CPV) was identified through the transverse sinus. Parallel incision were made in the left atrium and CPV, and extended to the vertical vein. An anastomosis using continuous suture was fashioned. She had a good postoperative course. The superior approach through the transverse sinus affords excellent exposure of the CPV and left atrium in situ in the neonatal period, if the mobilization of the aorta is completed, and the heart is not compressed or displaced. This approach is useful for supracardiac type of TAPVD.
一名11天大、患有紫绀和呼吸窘迫的新生儿入院。已经进行了插管和儿茶酚胺给药。血压为80/50 mmHg，心率为160次/分钟。使用利尿剂后每4小时尿量仅7毫升。经超声心动图诊断为心上型完全性肺静脉异位引流。未进行心导管检查即进行了急诊手术。经正中胸骨切开术后，游离主动脉。在体外循环下，将主动脉牵向左侧，上腔静脉牵向右侧，通过横窦识别出共同肺静脉干（CPV）。在左心房和CPV上做平行切口，并延伸至垂直静脉。采用连续缝合进行吻合。她术后恢复良好。如果完成主动脉游离，且心脏未受压或移位，经横窦的上入路在新生儿期能很好地暴露原位的CPV和左心房。这种入路对心上型完全性肺静脉异位引流很有用。
