Mainwaring Richard D, Patrick William L, Carrillo Sergio A, Ibrahimye Ali N, Muralidaran Ashok, Hanley Frank L
Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, California.
Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, California.
Ann Thorac Surg. 2016 Sep;102(3):877-882. doi: 10.1016/j.athoracsur.2016.03.011. Epub 2016 May 18.
Major aortopulmonary collateral arteries (MAPCAs) are the sole source of pulmonary blood flow in patients with pulmonary atresia and absent ductus arteriosus. The anatomy of MAPCAs can be highly variable, both in the number of MAPCAs supplying each lung and the anatomic origin and course of the MAPCAs. This study evaluated the prevalence and anatomy of retroesophageal MAPCAs in patients undergoing repair of pulmonary atresia/ventricular septal defect/MAPCAs.
This was a concurrent analysis of 68 consecutive patients (March 2013 through October 2015) undergoing a primary surgical procedure for pulmonary atresia/ventricular septal defect/MAPCAs. A detailed analysis of the MAPCA anatomy was made intraoperatively for each patient, including the total number of MAPCAs to each lung and the presence or absence of a retroesophageal course. These data were correlated with the preoperative cardiac catheterization images.
A retroesophageal MAPCA was identified during the operation in 45 of the 68 patients (67%), all of which were located on the side opposite the arch. For the 36 patients with a left aortic arch, 77% had a retroesophageal MAPCA compared with 53% of patients with a right arch. Forty-six percent of retroesophageal MAPCAs coursed within the muscular fibers of the esophagus (intraesophageal) and were more common to the left lung than the right (72% vs 32%). A midsegment stenosis was present in 84% of the retroesophageal MAPCAs, and this was more severe when the MAPCAs were intraesophageal than when they were not (80% vs 42%).
These data demonstrate that two-thirds of patients had a retroesophageal MAPCA and that there were significant differences in prevalence and anatomy depending on the side of the aortic arch. These data provide important insights into the origin and course of retroesophageal MAPCAs.
在肺动脉闭锁且动脉导管缺如的患者中，主-肺动脉侧支动脉（MAPCA）是肺血流的唯一来源。MAPCA的解剖结构具有高度变异性，既体现在供应每侧肺的MAPCA数量上，也体现在MAPCA的解剖起源和走行上。本研究评估了接受肺动脉闭锁/室间隔缺损/MAPCA修复术患者中食管后MAPCA的发生率及解剖结构。
这是一项对68例连续患者（2013年3月至2015年10月）进行的同期分析，这些患者均接受了肺动脉闭锁/室间隔缺损/MAPCA的初次外科手术。术中对每位患者的MAPCA解剖结构进行了详细分析，包括每侧肺的MAPCA总数以及是否存在食管后走行。这些数据与术前心脏导管检查图像相关联。
68例患者中有45例（67%）在手术中发现有食管后MAPCA，所有这些均位于与主动脉弓相对的一侧。对于36例左位主动脉弓患者，77%有食管后MAPCA，而右位主动脉弓患者中这一比例为53%。46%的食管后MAPCA走行于食管肌纤维内（食管内），且在左肺比右肺更常见（72%对32%）。84%的食管后MAPCA存在中段狭窄，当MAPCA为食管内走行时比非食管内走行时更严重（80%对42%）。
这些数据表明，三分之二的患者有食管后MAPCA，并且根据主动脉弓的侧别，其发生率和解剖结构存在显著差异。这些数据为食管后MAPCA的起源和走行提供了重要见解。
