Kim Donghee, Kwon Bo Sang, Kim Dong-Hee, Choi Eun Seok, Yun Tae-Jin, Park Chun Soo
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Chest Surg. 2022 Apr 5;55(2):151-157. doi: 10.5090/jcs.21.134.
We investigated surgical outcomes after the surgical repair of cor triatriatum sinister (CTS).
Thirty-two consecutive patients who underwent surgical repair of CTS from 1993 through 2020 were included in this study. The morphological characteristics, clinical features, and surgical outcomes were described and analyzed.
The median age and body weight at operation were 9 months (interquartile range [IQR], 3-238 months) and 7.5 kg (IQR, 5.8-49.6 kg), respectively. There were 16 males (50%). According to the modified Lucas classification, type IA (classical CTS) was most common (n=20, 62.5%). Atrial septal defect was associated in 22 patients (68.8%) and anomalous pulmonary venous return in 8 patients (25%). Pulmonary hypertension was preoperatively suspected with a high probability in 18 patients (56.3%). There was 1 early death (3.1%) after emergent membrane excision and hybrid palliation in a high-risk hypoplastic left heart syndrome patient. There were no late deaths. The overall survival rate was 96.9% at 15 years post-repair. No early survivors required reoperation during follow-up. Most survivors (31 of 32 patients, 96.9%) were in New York Heart Association functional class I at a median follow-up of 74 months (IQR, 39-195 months). At the latest echocardiography performed at a median of 42 months (IQR, 6-112 months) after repair, no residual lesion was observed except in 1 patient who had moderate pulmonary hypertension (mean pulmonary arterial pressure of 36 mm Hg).
Surgical repair of cor triatriatum could be performed safely and effectively with an extremely low risk of recurrence.
我们研究了左房三房心(CTS)手术修复后的手术结果。
本研究纳入了1993年至2020年期间连续32例行CTS手术修复的患者。描述并分析了其形态学特征、临床特点及手术结果。
手术时的中位年龄和体重分别为9个月(四分位间距[IQR],3 - 238个月)和7.5 kg(IQR,5.8 - 49.6 kg)。男性16例(50%)。根据改良卢卡斯分类法,IA型(典型CTS)最常见(n = 20,62.5%)。22例患者(68.8%)合并房间隔缺损,8例患者(25%)合并肺静脉异位引流。18例患者(56.3%)术前高度怀疑有肺动脉高压。1例高危左心发育不良综合征患者在急诊膜切除和杂交姑息治疗后早期死亡(3.1%)。无晚期死亡病例。修复后15年的总生存率为96.9%。早期存活者在随访期间均无需再次手术。中位随访74个月(IQR,39 - 195个月)时,大多数存活者(32例中的31例,96.9%)纽约心脏协会心功能分级为I级。在修复后中位42个月(IQR,6 - 112个月)进行的最新超声心动图检查中,除1例有中度肺动脉高压(平均肺动脉压36 mmHg)的患者外,未观察到残留病变。
三房心手术修复可安全有效地进行,复发风险极低。