Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Ann Thorac Surg. 2013 Dec;96(6):2198-202. doi: 10.1016/j.athoracsur.2013.06.079. Epub 2013 Sep 10.
Airway compression caused by an enlarged right pulmonary artery (RPA) in patients with a large shunt can usually be managed with intracardiac repair and concomitant anterior aortopexy. However, anterior aortopexy can be less effective or even dangerous in patients with coexisting arch anomaly due to excessive tension at the arch repair site. We have adopted anterior translocation of RPA without aortic transection in the group of patients with a high risk of postoperative airway compression. We reviewed the early and midterm results of this technique.
From February 2006 to January 2013, 8 patients underwent RPA anterior translocation as a concomitant procedure in one-stage repair of ventricular septal defect (VSD) and aortic arch anomaly to avoid postoperative airway problems. The enlarged RPA was disconnected from the main pulmonary artery (MPA) at its origin and was relocated anterior to the ascending aorta, and subsequently reimplanted to the U-shaped trapdoor incision at the anterolateral MPA wall. The mean age at operation was 34 days (median, 14 days, 6 to 77 days), and the mean body weight was 3.6 kg (2.15 to 5.5 kg). All patients had coarctation of the aorta and VSD except 1 who had aortic arch interruption. Five patients were dependent on a ventilator preoperatively. Six patients had evidence of preoperative bronchial compression (left; 4, right and left; 2), and 2 had a high probability of postoperative bronchial compression due to unusual anterior location of the descending aorta.
There was no early or late death. There were no postoperative airway problems such as reintubation or left lung atelectasis. Widely patent RPA was confirmed on postoperative computed tomographic angiography in all patients. The mean follow-up duration was 54.0 ± 17.1 months. One patient required balloon angioplasty for mild stenosis at the clamping site 3 years after the operation. All patients had no RPA stenosis at the latest follow-up evaluation.
Anterior translocation of the RPA as a concomitant procedure in one-stage repair of VSD and arch anomaly is a safe and effective procedure to avoid postoperative airway problems in high-risk patients.
在分流较大的患者中，由于右肺动脉（RPA）增大导致的气道压迫通常可以通过心内修复和同期进行的主动脉前固定术来治疗。然而，在伴有弓部异常的患者中，由于弓部修复部位的张力过大，主动脉前固定术可能效果不佳甚至有危险。我们对一组具有术后气道压迫高危风险的患者采用了不切断主动脉的 RPA 前移位术。我们回顾了这项技术的早期和中期结果。
自 2006 年 2 月至 2013 年 1 月，8 例患者在一期修复室间隔缺损（VSD）和主动脉弓畸形时同期行 RPA 前移位术，以避免术后气道问题。将增大的 RPA 在其起源处与主肺动脉（MPA）断开，并将其向前移位至升主动脉前方，然后重新植入到 MPA 前外侧壁的 U 形活瓣切口处。手术时的平均年龄为 34 天（中位数，14 天，6 至 77 天），平均体重为 3.6 公斤（2.15 至 5.5 公斤）。除 1 例主动脉弓中断外，所有患者均伴有主动脉缩窄和 VSD。术前有 5 例患者依赖呼吸机。6 例患者有术前支气管压迫的证据（左侧 4 例，右侧和左侧 2 例），2 例由于降主动脉异常的前位，有术后支气管压迫的高概率。
无早期或晚期死亡。无再插管或左肺不张等术后气道问题。所有患者术后 CT 血管造影均证实 RPA 通畅。平均随访时间为 54.0±17.1 个月。1 例患者术后 3 年因夹闭部位轻度狭窄行球囊血管成形术。所有患者在最新随访评估时均无 RPA 狭窄。
在一期修复 VSD 和弓部异常时同期行 RPA 前移位术是一种安全有效的方法，可以避免高危患者术后气道问题。
