TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION
TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION
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DOI：
10.1016/s0003-4975(10)60685-6
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发表时间：
1983-01-01
影响因子：
4.6
通讯作者：
DOTY, DB
中科院分区：
文献类型：
--
作者：
HAWKINS, JA;CLARK, EB;DOTY, DB
在 10 1/2 年期间（1972-1983 年），20 名婴儿通过手术修复了完全性肺静脉异常连接（TAPVC）。患者（5）术后死亡。对死亡率影响最大的因素是修复前患者的状况、手术年份和修复技术。 1976年之前与1976年之后的手术死亡率有显着差异（分别为57%[4/7]和8%[1/13]；P < 0.04）。 1976 年之前，用于左心房与肺总静脉吻合的几种技术涉及将心脏从其解剖位置移位。 1976 年之后，所有此类修复均采用了使用右心房切开术进入的标准方法。心内型TAPVC通过心包补片修复，引导血流通过房间隔缺损到达左心房。心上型和心下型通过扩大房间隔缺损进行修复，使穿过左心房后部的横向切口恰好覆盖肺静脉的后方。在心脏处于自然解剖位置的情况下对左心房和肺总静脉进行了大面积吻合，消除了吻合变形的可能性。使用心包补片来闭合房间隔缺损。显然，建立解剖学上正确的心房与肺总静脉吻合的正确经心房方法是降低 TAPVC 患者手术死亡率的重要因素。
Total anomalous pulmonary venous connection (TAPVC) was repaired by operation in 20 infants during a 10 1/2-yr period (1972-1983). Patients (5) died following operation. Factors that most affected mortality were the condition of the patient prior to repair, the year of operation and the technique used for repair. Operative mortality before 1976 was significantly different from that after 1976 (57% [4/7] vs. 8% [1/13], respectively; P < 0.04). Prior to 1976, the several techniques used for anastomosis of the left atrium to the common pulmonary vein involved displacement of the heart from its anatomical position. After 1976, a standard approach using a right atriotomy for access was adopted for all such repairs. Intracardiac type of TAPVC was repaired by pericardial patch to direct blood flow through the atrial septal defect to the left atrium. Supracardiac and infracardiac types were repaired by enlarging the atrial septal defect so that a transverse incision through the back of the left atrium was exactly overlying the pulmonary vein posteriorly. A large anastomosis of the left atrium and common pulmonary vein was made with the heart in its natural anatomical position, which eliminates the possibility of distortion of the anastomosis. A pericardial patch was used to close the atrial septal defect. Evidently, the right transatrial apprpoach of creating an anatomically correct anastomosis of the atrium to the common pulmonary vein is an important factor in reducing operative mortality in patients with TAPVC.