Jaschinski Christoph, Cussigh Christiane, Fonseca Elizabeth, Bruckner Tom, Karck Matthias, Loukanov Tsvetomir
Department of Cardiac Surgery, Universitatsklinikum Heidelberg, Heidelberg, Baden-Württemberg, Germany.
Department of Medical Biometry, Universitätsklinikum Heidelberg, Heidelberg, Baden-Württemberg, Germany.
Thorac Cardiovasc Surg. 2020 Jan;68(1):15-23. doi: 10.1055/s-0039-1693655. Epub 2019 Aug 6.
Different methods for surgical correction of partial anomalous pulmonary venous connection (PAPVC) exist. We evaluated the outcomes of four techniques regarding morbidity and mortality.
A total of 116 patients underwent PAPVC repair in our institution over a period of 20 years. Single-patch technique ( = 82 [71%], mean age: 18.59 ± 20.49 years), double-patch technique ( = 13 [11%], mean age: 43.18 ± 25.14 years), Warden's technique ( = 7 [6%], mean age: 10.04 ± 10.47 years), and direct implantation of anomalous pulmonary veins ( = 14 [12%], mean age: 14.42 ± 18.58 years) were examined.
Out of the 116 patients, one patient (0.9%) developed pulmonary hypertension after discharge and three patients (2.6%) with normal right cardiac function showed right ventricular failure. In total, a pacemaker was inserted in seven cases (6%). Three patients (2.6%) presented with persistent nonsinus rhythm during follow-up. This complication was most frequently seen in the double-patch group being significantly increased compared with the other groups ( = 0.035). One patient presented with a mild stenosis of the superior vena cava. There were two early, nonsurgery-related deaths and no late mortality.
Operative therapy of PAPVC has low postoperative morbidity and mortality. Therefore, surgical repair of this cardiac anomaly is a safe and reproducible treatment independent of the applied method. The surgical technique must be selected based on the anatomy and possible accompanying congenital heart defects. Special care should be taken when using the double-patch technique because of significant more frequent nonsinus rhythm events postoperatively.
存在多种用于手术矫正部分性肺静脉异位连接（PAPVC）的方法。我们评估了四种技术在发病率和死亡率方面的结果。
在20年期间，我们机构共有116例患者接受了PAPVC修复术。对单补片技术（n = 82 [71%]，平均年龄：18.59 ± 20.49岁）、双补片技术（n = 13 [11%]，平均年龄：43.18 ± 25.14岁）、沃登技术（n = 7 [6%]，平均年龄：10.04 ± 10.47岁）和直接植入异常肺静脉（n = 14 [12%]，平均年龄：14.42 ± 18.58岁）进行了研究。
116例患者中，1例患者（0.9%）出院后出现肺动脉高压，3例右心功能正常的患者出现右心室衰竭。总共7例（6%）患者植入了起搏器。3例患者（2.6%）在随访期间出现持续性非窦性心律。这种并发症在双补片组中最为常见，与其他组相比显著增加（P = 0.035）。1例患者出现上腔静脉轻度狭窄。有2例早期非手术相关死亡，无晚期死亡。
PAPVC的手术治疗术后发病率和死亡率较低。因此，这种心脏畸形的手术修复是一种安全且可重复的治疗方法，与所应用方法无关。必须根据解剖结构和可能伴随的先天性心脏缺陷选择手术技术。由于术后非窦性心律事件明显更频繁，使用双补片技术时应特别小心。
