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目的探讨左房顶径路矫治低体质量儿心上型完全性肺静脉异位引流(TAPVC)的疗效。方法选择本院2009年3月-2011年4月,低体质量TAPVC患儿12例。其中男7例,女5例;年龄10个月～12岁[(5.22±1.25)岁];体质量8.4～15.0(10.4±3.1)kg。患儿均在全麻、中低温体外循环下经左房顶径路完成矫治手术。正中切口纵劈胸骨入胸,经横窦,上腔静脉与升主动脉之间显露共同肺静脉干及左心房,将其侧侧吻合。体外循环时间52～102(67.2±14.2)min,其中主动脉阻断时间39～75(45.3±12.5)min。结果术后早期(30 d内)无死亡,其中低心排出量综合征5例、心房扑动1例、交界性心律1例、肺部感染5例,均经治愈出院。11例随访1～3 a,无死亡,其中出现交界性心律1例,余均为窦性心律;随访超声心动图示吻合口无压力阶差10例,轻度狭窄1例。结论在治疗心上型TAPVC时,选择左房顶径路治疗低体质量儿心上型TAPVC临床效果满意。
Objective To investigate the effect of left atrial topography on the treatment of low-grade infantile ventricular total anomalous pulmonary venous drainage (TAPVC). Methods Select our hospital March 2009 -2011 in April, 12 cases of low-quality TAPVC children. There were 7 males and 5 females, ranging in age from 10 months to 12 years [(5.22 ± 1.25) years] and body weight 8.4 to 15.0 (10.4 ± 3.1) kg. Children are in general anesthesia, hypothermia cardiopulmonary bypass by the left roof road to complete corrective surgery. The middle incision longitudinally split the chest into the chest, the transverse sinus, the superior vena cava and the ascending aorta revealed between the common pulmonary veins and the left atrium, the lateral anastomosis. The time of cardiopulmonary bypass was 52 ~ 102 (67.2 ± 14.2) min, and the aortic block time was 39 ~ 75 (45.3 ± 12.5) min. Results No death occurred in the early postoperative period (within 30 days). Among them, 5 were low cardiac output syndrome, 1 was atrial flutter, 1 was borderline rhythm and 5 were lung infections. All patients were cured and discharged. Eleven cases were followed up for 1-3 years without death, in which there was one case of borderline rhythm and the others were sinus rhythm. The follow-up echocardiography showed 10 cases of non-pressure gradient and 1 case of mild stenosis. Conclusions In the treatment of supraventricular TAPVC, the clinical efficacy of left atrial topography in treatment of low birth-weight TAPVC is satisfactory.