Jung Hyun-Jin, Bang Ji Hyun, Park Chun-Soo, Park Jeong-Jun, Im Yu-Mi, Yun Tae-Jin
Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
Seoul Women's College of Nursing, Seoul, Republic of Korea.
Pediatr Cardiol. 2016 Feb;37(2):290-4. doi: 10.1007/s00246-015-1276-4. Epub 2015 Oct 3.
Indications of sutureless repair (SR) for pulmonary vein anomalies have evolved from re-operational SR for pulmonary vein stenosis after the repair of total anomalous pulmonary venous drainage (TAPVD) to primary SR for TAPVD associated with right atrial isomerism or isolated TAPVD with small individual pulmonary veins (IPVs) and an unfavorable pulmonary vein anatomy. We sought to determine whether small IPVs outgrow somatic growth after primary SR. Between 2004 and 2013, 21 children underwent primary SR for TAPVD: 13 with a functionally single ventricle, 11 with right atrial isomerism, six with isolated TAPVD, and 13 with a pulmonary venous obstruction. TAPVD types were supracardiac in nine, infracardiac in 10, and mixed in two. Utilizing cardiac computed tomography (CT), the maximal diameter of each IPV was measured, and pulmonary vein index (PVI, summation of cross-sectional areas of all four IPVs divided by body surface area) was calculated. There were five early deaths after SR. Among survivors, 10 had both preoperative and postoperative cardiac CT at a 3.6-month median interval. On postoperative cardiac CT, IPVs were patent in all patients except one who developed a left lower pulmonary vein obstruction. There was a 71 ± 48 % postoperative increase in the actual diameter of all four IPVs, and PVI increased significantly from 215 ± 55 to 402 ± 117 mm(2)/m(2) (P value = 0.005). IPVs outgrew somatic growth after primary SR of TAPVD. Primary SR may be a useful measure in TAPVD patients whose IPVs are small.
肺静脉异常的无缝合修复（SR）适应症已从完全性肺静脉异位引流（TAPVD）修复术后肺静脉狭窄的再次手术SR，发展到与右心房异构相关的TAPVD或具有小的独立肺静脉（IPV）且肺静脉解剖结构不利的孤立性TAPVD的初次SR。我们试图确定初次SR后小的IPV是否会超过身体生长速度。2004年至2013年期间，21例儿童接受了TAPVD的初次SR：13例患有功能性单心室，11例患有右心房异构，6例患有孤立性TAPVD，13例患有肺静脉梗阻。TAPVD类型为心上型9例，心下型10例，混合型2例。利用心脏计算机断层扫描（CT）测量每个IPV的最大直径，并计算肺静脉指数（PVI，所有四个IPV横截面积之和除以体表面积）。SR后有5例早期死亡。在幸存者中，10例在中位间隔3.6个月时进行了术前和术后心脏CT检查。术后心脏CT显示，除1例发生左下肺静脉梗阻外，所有患者的IPV均通畅。所有四个IPV的实际直径术后增加了71±48%，PVI从215±55显著增加到402±117mm²/m²（P值=0.005）。TAPVD初次SR后IPV超过了身体生长速度。初次SR可能是IPV较小的TAPVD患者的一种有用措施。
