Serraf A, Belli E, Roux D, Sousa-Uva M, Lacour-Gayet F, Planché C
Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Le Plessis-Robinson, France.
Ann Thorac Surg. 1998 May;65(5):1391-3. doi: 10.1016/s0003-4975(98)00141-6.
The main goal in the surgical repair of total anomalous pulmonary venous drainage is to reestablish a wide patent connection between the common pulmonary vein and the left atrium. Several techniques have been proposed for achieving this objective, each of which has advantages and disadvantages. The superior approach between the superior vena cava and the ascending aorta was introduced in 1976 for the repair of supracardiac forms of total anomalous pulmonary venous drainage, but it often provides a less than optimum exposure, particularly in tiny infants. We proposed a modification of this approach that includes division of the ascending aorta and offers excellent exposure.
Seventeen patients (15 neonates and 2 infants) with supracardiac total anomalous pulmonary venous drainage (n = 13) or mixed forms of total anomalous pulmonary venous drainage (n = 4) underwent surgical repair with the use of the modified superior approach. Circulatory arrest was not required in 10 patients and the mean cross-clamp time was 32.5 +/- 13.8 minutes.
There was 1 postoperative death resulting from intractable pulmonary hypertension in a compromised infant who was referred to our unit receiving extracorporeal membrane oxygenation. One patient with common hypoplasia underwent reoperation twice at 2 months and then 3 months after the first procedure. All the other patients had a smooth postoperative course, and midterm evaluation showed a widely patent anastomosis between the common vein and the left atrium.
The modified superior approach for the repair of supracardiac total anomalous pulmonary venous drainage can be useful to enhance exposure during surgical repair and may contribute to improved patient outcome.
完全性肺静脉异位引流手术修复的主要目标是在共同肺静脉和左心房之间重建一个宽大的通畅连接。为实现这一目标已提出了几种技术，每种技术都有其优缺点。1976年引入了上腔静脉与升主动脉之间的上入路，用于修复心上型完全性肺静脉异位引流，但它通常提供的暴露欠佳，尤其是在微小婴儿中。我们提出了对该入路的一种改良方法，包括切断升主动脉，可提供极佳的暴露。
17例心上型完全性肺静脉异位引流（n = 13）或混合型完全性肺静脉异位引流（n = 4）患者（15例新生儿和2例婴儿）采用改良上入路进行手术修复。10例患者无需循环阻断，平均阻断时间为32.5±13.8分钟。
1例病情严重的婴儿因顽固性肺动脉高压术后死亡，该婴儿在转至我院时接受体外膜肺氧合治疗。1例合并共同发育不全的患者在首次手术后2个月和3个月分别接受了两次再次手术。所有其他患者术后过程顺利，中期评估显示共同静脉与左心房之间吻合口通畅。
改良上入路用于心上型完全性肺静脉异位引流的修复，有助于在手术修复过程中增加暴露，可能有助于改善患者预后。
