Matsuda H, Hirose H, Nakano S, Shimazaki Y, Kishimoto H, Kobayashi J, Arisawa J, Kawashima Y
Ann Thorac Surg. 1985 Dec;40(6):593-8. doi: 10.1016/s0003-4975(10)60355-4.
Nine consecutive patients with ventricular septal defect (VSD) and pulmonary atresia associated with large aortopulmonary collateral arteries underwent primary repair with simultaneous ligation of these collateral arteries. The patients ranged from 1 year to 20 years old (average, 8.0 years). The average number of large aortopulmonary collateral arteries was 1.9 per patient. Arborization abnormality was found in 5 patients. The aortopulmonary collateral arteries were reached solely through a median sternotomy, with dissection of the posterior pericardium or anterior mediastinal pleura before or after the initiation of cardiopulmonary bypass. The immediate postoperative peak pressure ratio between the right and left ventricles was higher in patients with an arborization abnormality, but all ratios ranged from 0.60 to 0.87. There was 1 operative death. Postoperative transcatheter embolization for a residual large aortopulmonary collateral artery was required in 1 patient and pulmonary infarction of mild degree developed with spontaneous recovery in another. These results indicate the usefulness and safety of simultaneous ligation of large aortopulmonary collateral arteries through median sternotomy, even with an associated arborization abnormality.
9例患有室间隔缺损（VSD）且伴有粗大主肺动脉侧支动脉的肺动脉闭锁患者接受了一期修复手术，同时结扎这些侧支动脉。患者年龄从1岁至20岁不等（平均8.0岁）。每位患者的粗大主肺动脉侧支动脉平均数量为1.9支。5例患者发现分支异常。主肺动脉侧支动脉仅通过正中胸骨切开术显露，在体外循环开始之前或之后切开后心包或前纵隔胸膜进行分离。分支异常患者术后即刻右心室与左心室的峰值压力比值较高，但所有比值范围为0.60至0.87。有1例手术死亡。1例患者术后因残留粗大主肺动脉侧支动脉需要进行经导管栓塞治疗，另1例患者发生轻度肺梗死，但自行恢复。这些结果表明，通过正中胸骨切开术同时结扎粗大主肺动脉侧支动脉是有用且安全的，即使存在相关的分支异常。
