Current topics in surgery for isolated total anomalous pulmonary venous connection
Current topics in surgery for isolated total anomalous pulmonary venous connection
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DOI：
10.1007/s00595-014-0877-5
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发表时间：
2014-03
期刊：
影响因子：
2.5
通讯作者：
Naoki Yoshimura;K. Fukahara;A. Yamashita;Y. Doki;Katsunori Takeuchi;Tomonori Higuma;K. Senda;M. Toge;Tatsuro Matsuo;Saori Nagura;Masaya Aoki;Kimimasa Sakata;Hayato Obi
中科院分区：
文献类型：
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作者：
Naoki Yoshimura;K. Fukahara;A. Yamashita;Y. Doki;Katsunori Takeuchi;Tomonori Higuma;K. Senda;M. Toge;Tatsuro Matsuo;Saori Nagura;Masaya Aoki;Kimimasa Sakata;Hayato Obi
手术矫正完全异常肺静脉连接（TAPVC）仍然是一个挑战，据报道早期死亡率高达20%。在这篇综述文章中，我们描述了几个主题，包括新生儿手术，多探测器计算机断层扫描（MDCT）诊断和初级无缝线修复。几项研究报告的死亡率约为10%，并证明新生儿的住院死亡率没有变化，尽管包括老年患者在内的队列的总体死亡率有所改善。先前的报告指出，手术时体重过轻、术前肺静脉阻塞（PVO）和体外循环时间延长是院内死亡的危险因素。随着新技术的发展，多层螺旋ct已成为一种良好的诊断方式，用于术前和术后的评估。MDCT可描绘出垂直静脉及非典型血管进入全身静脉的引流部位，也可评价垂直静脉是否存在梗阻。随着修复后PVO的良好经验，无缝线修复作为主要手术的适应症已经扩大到婴儿，包括那些在TAPVC修复后有发生PVO风险的婴儿。初步无缝线修复已被证明特别适用于困难的患者群体，如先天性PVO、伴有小肺静脉的心下TAPVC或混合型TAPVC。
Surgical correction of total anomalous pulmonary venous connection (TAPVC) remains a challenge, with reported early mortality rates of up to 20 %. In this review article, we describe several topics, including surgery for neonates, diagnoses with multidetector computed tomography (MDCT), and primary sutureless repair. Several studies have reported mortality rates of around 10 %, and demonstrated unchanged hospital mortality in neonates, despite improvement of the overall mortality of cohorts including older patients. Previous reports identified a low body weight at the time of the operation, preoperative pulmonary venous obstruction (PVO), and a prolonged cardiopulmonary bypass time as risk factors for hospital mortality. With the development of new technologies, MDCT has become a good diagnostic modality for use in the pre- and post-operative evaluation. MDCT delineates the drainage site of the vertical vein and the atypical vessel into the systemic vein, and it can also evaluate the existence of obstruction in the vertical vein. Following favorable experiences with post-repair PVO, the indications for sutureless repair as a primary operation have been expanded for infants, including those at risk of developing PVO after the repair of TAPVC. Primary sutureless repair has proven especially useful for difficult patient groups, such as those with congenital PVO, infracardiac TAPVC with small pulmonary veins, or mixed-type TAPVC.