Double-decker repair of partial anomalous pulmonary venous return into the superior vena cava
Double-decker repair of partial anomalous pulmonary venous return into the superior vena cava
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DOI：
10.1016/j.jtcvs.2019.01.057
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发表时间：
2019-05-01
影响因子：
6
通讯作者：
Yaku, Hitoshi
中科院分区：
文献类型：
--
作者：
Hongu, Hisayuki;Yamagishi, Masaaki;Yaku, Hitoshi
目的：部分性肺静脉异常回流（PAPVR）至上级腔静脉（SVC）的常规手术仍存在严重并发症，如晚期SVC和/或肺静脉阻塞和室上性心律失常。我们的目的是介绍我们新开发的手术技术，最小的右心房切开术和双管安排的体静脉和肺静脉通道（双层技术）。方法：从1998年至2018年，21例连续PAPVR的SVC患者接受了这种新的程序。患者的中位年龄和体重分别为4.4岁和16.5 kg。2例女性患者接受了侧开胸术。术后两个静脉通道的血流动力学进行了评估，在6例患者的时间分辨三维磁共振相位对比imaging。结果：中位随访时间为11.0年。无早期死亡和晚期死亡。没有患者需要再次手术和/或干预。所有患者均维持正常窦性心律，无室上性心律失常发生。新生上腔静脉和新生静脉通道的平均血流速度分别为0.40和0.30 m/s。使用时间分辨三维磁共振相位对比成像，直和nonrestricting流和低壁面切应力可视化在两个静脉channel.Conclusions：我们新开发的双层技术是一个有用的替代手术PAPVR上腔静脉。使用这种方法可以完全避免晚期并发症。这两个渠道的增长潜力也得到了保持。
Objective: Conventional procedures for partial anomalous pulmonary venous return (PAPVR) to the superior vena cava (SVC) still have serious complications, such as late SVC and/or pulmonary venous obstruction and supraventricular arrhythmia. We aimed to introduce our newly developed surgical technique with minimum right atriotomy and double-barreled arrangement of systemic and pulmonary venous channels (double-decker technique).Methods: From 1998 to 2018, 21 consecutive patients with PAPVR to the SVC underwent this new procedure. The patients' median age and body weight were 4.4 years and 16.5 kg, respectively. Two female patients underwent lateral thoracotomy. Postoperative hemodynamics of both venous channels were assessed using time-resolved 3-dimensional magnetic resonance phase contrast imaging in 6 patients.Results: The median follow-up period was 11.0 years. There was no early mortality and late death. No patient required reoperation and/or intervention. All patients maintained normal sinus rhythm, and supraventricular arrhythmia did not occur. The median blood flow velocity of the neo-SVC and neopulmonary venous channel was 0.40 and 0.30 m/s, respectively. Using time-resolved 3-dimensional magnetic resonance phase contrast imaging, the straight and nonrestrictive flow and low wall shear stress were visualized in both venous channels.Conclusions: Our newly developed double-decker technique is a useful alternative surgical procedure for PAPVR to the SVC. Late complications can be completely avoided using this method. Growth potential of both channels is also maintained.