Xiang Yonghua, Cheng Guanxun, Jin Ke, Zhang Xuehua, Yang Yuan
Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Radiology, Hunan Children's Hospital, University of South China, Changsha, China.
Int J Cardiovasc Imaging. 2018 Dec;34(12):1969-1975. doi: 10.1007/s10554-018-1405-2. Epub 2018 Jun 25.
Detailed preoperative imaging of total anomalous pulmonary venous connection (TAPVC) is critical to ensuring adequate surgical planning and preoperative decision making. The purpose of this study was to describe the computed tomography findings of TAPVC and identify morphologic death risk factors. We conducted a retrospective study included 70 patients with TAPVC between May 2014 and June 2017 in Hunan Children's Hospital. All available clinical data and computed tomography imaging were reviewed, and survival time was followed-up. Life Tables analysis was used to estimate survival rates. Patient survival was described with Kaplan-Meier curves. Cox Regression model was used to test the potential risk factors. TAPVC was subdivided into four types. Of 70 cases, 42 (60%) had supracardiac, 13 (18.6%) had cardiac, 8 (11.4%) had infracardiac, and 7 (10%) had mixed type. Pulmonary venous obstruction (PVO) was found in 30 (42.9%) of 70 patients in this group. Of all concurrent abnormalities, atrial septal defect (ASD) was the most common (98.6%), followed by patent ductus arteriosus (PDA; 31, 44.3%), and persistent left superior vena cava (PLSVC; 5, 7.1%). 1, 3, 6 and 12-month survival rates were 76, 61, 49, and 38% respectively. Risk factors for mortality in multivariable analysis comprised PVO, McGoon index (MGI), and mode of delivery. Various concurrent abnormalities and great morphological heterogeneity were observed in patients with TAPVC. Patients with TAPVC had a highest mortality in the neonatal period. PVO, smaller MGI and caesarean are important predictors for mortality.
完全性肺静脉异位连接（TAPVC）的详细术前影像学检查对于确保充分的手术规划和术前决策至关重要。本研究的目的是描述TAPVC的计算机断层扫描结果并确定形态学死亡风险因素。我们进行了一项回顾性研究，纳入了2014年5月至2017年6月在湖南省儿童医院就诊的70例TAPVC患者。回顾了所有可用的临床资料和计算机断层扫描影像，并对生存时间进行了随访。采用寿命表分析来估计生存率。用Kaplan-Meier曲线描述患者生存率。采用Cox回归模型检验潜在风险因素。TAPVC分为四种类型。70例患者中，心上型42例（60%），心内型13例（18.6%），心下型8例（11.4%），混合型7例（10%）。该组70例患者中有30例（42.9%）发现有肺静脉梗阻（PVO）。在所有并发异常中，房间隔缺损（ASD）最为常见（98.6%），其次是动脉导管未闭（PDA；31例，44.3%）和永存左上腔静脉（PLSVC；5例，7.1%）。1个月、3个月、6个月和12个月的生存率分别为76%、61%、49%和38%。多变量分析中死亡的风险因素包括PVO、麦戈恩指数（MGI）和分娩方式。TAPVC患者观察到各种并发异常和巨大的形态学异质性。TAPVC患者在新生儿期死亡率最高。PVO、较小的MGI和剖宫产是死亡的重要预测因素。
