Kanaoka T, Murashita T, Takigami K, Kubota T, Yasuda K
Department of Cardiovascular Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 Aug;45(8):1152-8.
In the repair of total anomalous pulmonary venous connection (TAPVC), some reports suggest that atrial arrhythmia was occurred as a late post-operative complication when the extended incision over the both atria was made by lateral approach, while the posterior approach in adult case often is difficult to expose operative field. A 42-year-old female patient with supracardiac type of TAPVC, Darling Ia type, was successfully corrected using superior approach. During procedure, the excellent operative field was obtained and large size of anastomosis between the posterior wall of left atrium and the common pulmonary vein could be carried out without lifting up the apex of the heart or the extensive incision of the both atria. The post-operative angiogram revealed no stenosis or distortion at the anastomotic site. We reviewed the 17 adult cases of supracardiac type of TAPVC repair in Japan, however, the superior approach was not reported. Our experience would suggest the superior approach is useful in the adult patient to repair supracardiac type of TAPVC. In addition to surgical approach, the pitfall of the post-operative hemodynamic changes in adult case of TAPVC repair was discussed.
在完全性肺静脉异位连接（TAPVC）的修复中，一些报告表明，当通过外侧入路在双侧心房上做延长切口时，房性心律失常会作为术后晚期并发症出现，而在成人病例中，后入路往往难以暴露手术视野。一名42岁的女性患者，患有心上型TAPVC（达林Ia型），采用上入路成功矫正。手术过程中，获得了良好的手术视野，在不抬起心尖或广泛切开双侧心房的情况下，成功进行了左心房后壁与共同肺静脉之间的大尺寸吻合。术后血管造影显示吻合部位无狭窄或扭曲。我们回顾了日本17例成人心上型TAPVC修复病例，但未报告上入路。我们的经验表明，上入路对成人心上型TAPVC的修复是有用的。除了手术入路外，还讨论了成人TAPVC修复术后血流动力学变化的陷阱。
