Department of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
Eur J Cardiothorac Surg. 2013 Mar;43(3):635-40. doi: 10.1093/ejcts/ezs376. Epub 2012 Jul 2.
The objective was to evaluate primary sutureless repair of total anomalous pulmonary venous return (TAPVR) in neonates using a modified technique that minimizes hypothermia and circulatory arrest times.
From 2009 to 2011, seven consecutive patients underwent primary sutureless repair for the treatment of TAPVR, by which the prepared posterior pericardium was sutured to an opening in the left atrium. Three patients had the obstructed infracardiac type, and four patients had the unobstructed supracardiac type of TAPVR. Moderate hypothermia was used in all patients with a median temperature of 28°C (26-32). Circulatory arrest was not used except for the opening of the collector, which lasted between 3 and 5 min. The connecting vein was ligated in all seven patients (five during repair and two early postoperatively). The follow-up was 100% complete, with a median duration of 652 (range 370-1023) days.
There was no operative mortality and no late death. No patient required reoperation. Postoperative echocardiography showed unobstructed pulmonary venous flow in all patients. Recurrent pulmonary venous stenosis was not seen during the follow-up in any patient.
The sutureless technique is an effective technique with potential advantages even for the primary correction of TAPVR. With the described technique, the need for circulatory arrest is substantially reduced. Not handling the pulmonary venous collector by avoiding a direct anastomosis may contribute to better compliance, better growth and the absence of subsequent stenosis.
评估一种改良技术在新生儿完全性肺静脉异位引流（TAPVR）中的应用，该技术可最大限度地减少低温和循环阻断时间。
2009 年至 2011 年，7 例连续患者采用无缝线修复术治疗 TAPVR，其中制备的后心包缝至左心房开口。3 例患者为下腔型 TAPVR，4 例患者为上腔型 TAPVR。所有患者均采用中度低温，平均温度为 28°C（26-32°C）。除了收集器的开放外，不使用循环阻断，持续时间为 3-5 分钟。7 例患者均结扎连接静脉（5 例在修复过程中，2 例在术后早期）。随访率为 100%，平均随访时间为 652 天（范围 370-1023 天）。
无手术死亡，无晚期死亡。无患者需要再次手术。术后超声心动图显示所有患者均有通畅的肺静脉血流。在随访期间，无患者出现复发性肺静脉狭窄。
无缝线技术是一种有效的技术，即使对于 TAPVR 的初次矫正也具有潜在优势。采用描述的技术，显著减少了循环阻断的需要。避免直接吻合处理肺静脉收集器可能有助于更好的顺应性、更好的生长和不存在后续狭窄。
