Imoto Y, Kado H, Asou T, Shiokawa Y, Tominaga R, Yasui H
Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Kyushu University, Japan.
Ann Thorac Surg. 1998 Oct;66(4):1394-7. doi: 10.1016/s0003-4975(98)00754-1.
The mixed type of total anomalous pulmonary venous connection is a rare condition in which some diagnostic and surgical problems still remain to be solved.
In 9 patients a single pulmonary vein was connected to the systemic vein at a site different from the drainage site of the confluence of three other pulmonary veins. In 2 other patients, four pulmonary veins made a confluence which had two drainage sites. Correct diagnosis was made in all 7 patients who received cardiac catheterization but only in 5 of the 9 patients by color Doppler echocardiography. Total correction was performed in 3 patients and the single anomalous pulmonary vein was left uncorrected in 8 other patients.
There were two in-hospital deaths. Seven patients with a single residual anomalous pulmonary vein have been in good condition without clinical symptoms of congestive heart failure or pulmonary hypertension.
Diagnosis of mixed type of total anomalous pulmonary venous correction by echocardiography is sometimes difficult. When a mixed type is suspected, cardiac catheterization is recommended if the condition of the patient permits it. A single anomalous pulmonary vein may be left uncorrected without serious complications, but close observation is needed to prevent congestive heart failure and pulmonary vascular obstructive disease.
混合型完全性肺静脉异位连接是一种罕见的病症，其中一些诊断和手术问题仍有待解决。
9例患者中，一条肺静脉在与其他三条肺静脉汇合处引流部位不同的位置连接到体静脉。另外2例患者中，四条肺静脉形成一个有两个引流部位的汇合处。接受心导管检查的所有7例患者均做出了正确诊断，但彩色多普勒超声心动图仅在9例患者中的5例做出了正确诊断。3例患者进行了完全矫正，另外8例患者中单一异常肺静脉未予矫正。
有2例院内死亡。7例有单一残留异常肺静脉的患者情况良好，无充血性心力衰竭或肺动脉高压的临床症状。
通过超声心动图诊断混合型完全性肺静脉矫正有时很困难。当怀疑为混合型时，如果患者情况允许，建议进行心导管检查。单一异常肺静脉可不进行矫正，且无严重并发症，但需要密切观察以预防充血性心力衰竭和肺血管阻塞性疾病。
