Mixed total anomalous pulmonary venous connection: Anatomic variations, surgical approach, techniques, and results
Mixed total anomalous pulmonary venous connection: Anatomic variations, surgical approach, techniques, and results
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DOI：
10.1016/j.jtcvs.2007.08.028
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发表时间：
2008-01-01
影响因子：
6
通讯作者：
Venugopal, Panangipalli
中科院分区：
文献类型：
--
作者：
Chowdhury, Ujjwal K.;Airan, Balram;Venugopal, Panangipalli
目的：探讨混合型完全性肺静脉异位引流的形态特征及可能导致术后死亡率持续升高的危险因素。方法：57例混合型完全性肺静脉异位引流患者，年龄15天~18岁，中位数6个月。23例为“2+2”型(I类)，29例为“3+1”型(II类)，5例为不同组合的肺静脉连接(III类)。结果：手术死亡率19.3%，晚期病死率4.3%。平均随访63.26+/-58.47个月，精算生存率分别为86.9%+/-0.07%、86.2%+/-0.06%和20.0%+/-0.18%(LOG-RANK，P=.001)。最后一次随访时，所有存活者(n=43)的Ross临床心力衰竭评分均为0~2。结论：混合型完全性肺静脉异位引流以“2+2”型为主，其次为“3+1”型。横断面超声心动图和/或计算机断层血管造影术是强制性的，以提供必要的诊断信息和确定解剖结构。Logistic回归分析显示，2个月以下、完全肺静脉异位引流梗阻、围手术期肺动脉高压危象是死亡的重要危险因素。混合性TAPVC的III型患者的死亡风险是后者的5.85倍(95%可信区间：1.46-35.68；P=0.02)。对个别患者采用的精确技术取决于解剖引流的方式，建议采用个性化的手术入路。
Objective: The purpose of this study was to identify the morphologic characteristics and other risk factors that may predispose patients with mixed totally anomalous pulmonary venous connection to continuing high mortality after surgery.Methods: Fifty-seven consecutive patients aged 15 days to 18 years (median, 6 months) underwent rechanneling of mixed totally anomalous pulmonary venous connection. Twenty-three patients had "2+2" pattern (I category), 29 had "3+1" pattern (II category), and 5 patients had pulmonary venous connections of different combinations (III category). Obstructive patterns involving one or more pulmonary veins were present in 19 (33.3%) patients.Results: Operative and late mortality rates were 19.3% and 4.3%, respectively. At a mean follow-up of 63.26 +/- 58.47 months, actuarial survival was 86.9% +/- 0.07% in category I, 86.2% +/- 0.06% in category II, and 20.0% +/- 0.18% in category III (log-rank, P = .001), respectively. At their last follow-up, all survivors (n = 43) had a Ross clinical heart failure score of 0 to 2.Conclusions: Patients with a "2+2" pattern of mixed totally anomalous pulmonary venous connection constitute the safe anatomic category for rechanneling, followed by the "3+1" variety. Cross-sectional echocardiography and/or computed tomographic angiography are mandatory to provide necessary diagnostic information and define the anatomy. Patients aged 2 months or younger, obstructive totally anomalous pulmonary venous connection, and perioperative pulmonary hypertensive crises were significant risk factors for death by logistic regression analysis. The risk of death was 5.85 times higher (95% confidence interval: 1.46-35.68; P = .02) in patients with category III of mixed TAPVC. The precise technique adopted in an individual patient depends on the pattern of anatomic drainage, and an individualized surgical approach is recommended.