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[肺静脉狭窄。2例报告并文献复习]

[Pulmonary vein stenosis. Report of 2 cases and review of the literature].

作者信息

Zamorano M de M

机构信息

Instituto Dante Pazzanese de Cardiologia, São Paulo.

出版信息

Arq Bras Cardiol. 1995 Jul;65(1):47-53.

PMID:8546596
Abstract

Topical congenital pulmonary vein stenosis is a uncommon defect, both isolated or associated to other cardiac abnormalities. Only the localization of the lesions seems to affect the survival, because 60% of survival cases has unilateral stenosis; the severity of associated cardiac lesions become the prognosis poor. We describe two cases: 1st case, a 43 days old boy presented with heart failure and convulsion and had a diagnosis of pulmonary hypertension, atrial septal defect and tricuspid regurgitation, without pulmonary abnormalities. He had recurrent pulmonary infections and a cerebral ischemia in the following months, and died at 15 months of age for sepsis. Autopsy revealed stenosis and atresia in all pulmonary veins, with venous and arterial hypertension. There was also aortic hypoplasia and aortic and tricuspid valves indifferentiation; 2nd case, a 7 days old girl had a diagnosis of aortic coarctation and atrial and ventricular septal defects. Surgical corrections, at 38 and 46 days old, firstly of the aortic coarctation and after for the septal defects, disclosed and relief a supra-valvar mitral stenosis, but she remained on heavy respiratory insufficiency. At 6 months old, she returned to the hospital with dyspnea and cianosis, heart failure and hemoptisis; a sepsis developed and she died. At autopsy, there were severe pulmonary vein stenosis on the left and in the superior right veins, with pulmonary hypertension and hemorrhage.

摘要

局限性先天性肺静脉狭窄是一种罕见的缺陷,可单独存在或与其他心脏异常相关。似乎只有病变的部位会影响生存率,因为60%存活的病例为单侧狭窄;相关心脏病变的严重程度会使预后变差。我们描述两例病例:第一例,一名43天大的男婴出现心力衰竭和惊厥,诊断为肺动脉高压、房间隔缺损和三尖瓣反流,无肺部异常。在接下来的几个月里,他反复发生肺部感染和脑缺血,15个月大时因败血症死亡。尸检发现所有肺静脉均有狭窄和闭锁,伴有静脉和动脉高压。还存在主动脉发育不全以及主动脉瓣和三尖瓣分化不良;第二例,一名7天大的女婴诊断为主动脉缩窄以及房间隔和室间隔缺损。分别在38天和46天时进行了手术矫正,先矫正主动脉缩窄,之后矫正间隔缺损,术中发现并缓解了瓣上二尖瓣狭窄,但她仍有严重的呼吸功能不全。6个月大时,她因呼吸困难、发绀、心力衰竭和咯血再次入院;发生了败血症并死亡。尸检发现左肺静脉以及右上肺静脉有严重狭窄,伴有肺动脉高压和出血。

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