Ying Liyang,Liu Xiwang,Yu Jiangen,et al.Treatment of complete anomalous pulmonary venous drainage with obstruction[J].Journal of Clinical Pediatric Surgery,,22():425-430.[doi:10.3760/cma.j.cn101785-202204072-005]
Treatment of complete anomalous pulmonary venous drainage with obstruction
- Keywords:
- Pulmonary Veins; Emergency Treatment; Surgical Procedures; Operative; Child
- Abstract:
- Objective To summarize and evaluate the therapeutic effect of total anomalous pulmonary venous drainage with obstruction.Methods The clinical data of 189 children treated with TAPVC surgery in Children’s Hospital Affiliated to Zhejiang University School of Medicine from January 2010 to December 2019 were retrospectively analyzed,including 36 cases in the obstruction group and 153 cases in the non-obstruction group.The obstruction group contained 20 males and 16 females with age 1~140 (29.1±28.7) d and body weight at the time of operation 2.4~6.5 (3.6±0.9) kg.According to the postoperative death,the patients were further divided into the obstruction death group (5 cases) and the obstruction survival group (31 cases). Compare two groups of preoperative lactic acid levels,preoperative left ventricular end-diastolic volume index,extracorporeal circulation time,postoperative mechanical ventilation time,postoperative Extracorporeal Membrane Oxygenation (ECMO) support cases,delayed chest closure cases,multifunctional organ failure cases,peritoneal dialysis cases,arrhythmia cases,postoperative pulmonary hypertension crisis cases and pulmonary venous obstruction cases.35 cases were done with the vertical veins ligation and establishment of the connection between pulmonary vein and left atrium,without sutureless technique of pericardium in situ.Results Comparing the obstruction group and the non-obstruction group, ages were (29.1±28.7) vs.(98.3±121.6) days, body weight (3.6±0.9) vs.(5.1±3.4) kg, neonatal cases 21 (58.3%) vs.32 (20.9%), pulmonary venous velocity (1.4±0.5) vs.(1.1±0.4) m/s, delayed chest closure cases 15(41.6%) vs.10(6.5%), death cases 5(13.9%) vs. 10(6.5%). There were statistically significant differences in age, body weight, neonatal proportion, pulmonary venous velocity, delayed chest closure and death between the two groups (P<0.05).Comparing the obstruction death group and the obstruction survival group,lactic acid levels were (6.7±3.8) vs.(2.5±1.2) mmol/L,left ventricular end-diastolic volume indices (27.1±19.5) vs.(29.2±16.8) mL/m2,extracorporeal circulation time (216.3±64.3) vs.(159.3±73.4) mins,postoperative mechanical ventilation time (17.5±13.5) vs.(4.8±5.2) d,ECMO support cases 3 (60%) vs.1 (3.2%),delayed chest closure cases 4(80%) vs.11(35.5%),multifunctional organ failure cases 3 (60%) vs.0,peritoneal dialysis cases 4(80%) vs.16(51.6%),arrhythmia 2(40%) vs.3(9.7%),pulmonary hypertension crisis cases 3(60%) vs.1(3.2%), pulmonary venous obstruction cases 2(40%) vs.4(12.9%) respectively.There were statistically significant differences in preoperative lactic acid,extracorporeal circulation time,postoperative mechanical ventilation time,ECMO support cases,multifunctional organ failure cases and postoperative pulmonary hypertension crisis cases between the two groups (P<0.05). No pulmonary vein obstruction was found in the surviving children after 6 months of follow-up. Conclusion The operative mortality of children with complete pulmonary vein obstruction was high.Various techniques were used to expand the anastomosis during the operation.The early death was related to multiple organ failure and the perioperative application of ECMO,delayed chest closure and peritoneal dialysis can reduce the mortality.Pulmonary vein obstruction induced to the medium and long-term death.
References:
[1] Jonas RA.Comprehensive surgical management of congenital heart disease[M].London:CRC Press,2004:402-413.DOI:10.1201/b13620.
[2] Shi GC,Zhu ZQ,Chen JM,et al.Total anomalous pulmonary venous connection:the current management strategies in a pediatric cohort of 768 patients[J].Circulation,2017,135(1):48-58.DOI:10.1161/CIRCULATIONAHA.116.023889.
[3] Harada T,Nakano T,Oda S,et al.Surgical results of total anomalous pulmonary venous connection repair in 256 patients[J].Interact Cardiovasc Thorac Surg,2019,28(3):421-426.DOI:10.1093/icvts/ivy267.
[4] Padalino MA,Cavalli G,De Franceschi M,et al.Surgical outcomes of total anomalous pulmonary venous connection repair:a 22-year experience[J].J Card Surg,2014,29(5):678-685.DOI:10.1111/jocs.12399.
[5] Sakamoto T,Nagashima M,Umezu K,et al.Long-term outcomes of total correction for isolated total anomalous pulmonary venous connection:lessons from 50-years’ experience[J].Interact Cardiovasc Thorac Surg,2018,27(1) 20-26.DOI:10.1093/icvts/ivy034.
[6] 李晓华,陈泽文,陈寄梅,等.Sutureless技术矫治新生儿完全性肺静脉异位引流单中心应用体会[J].中华胸心血管外科杂志,2018,34(11):675-678.DOI:10.3760/cma.j.issn.1001-4497.2018.11.009. Li XH,Chen ZW,Chen JM,et al.Retrospective single center analysis:Sutureless technique for neonates with total anomalous pulmonary venous connection[J].Chin J Thorac Cardiovasc Surg,2018,34(11):675-678.DOI:10.3760/cma.j.issn.1001-4497.2018.11.009.
[7] Wu YH,Wu ZC,Zheng JM,et al.Sutureless technique versus conventional surgery in the primary treatment of total anomalous pulmonary venous connection:a systematic review and meta-analysis[J].J Cardiothorac Surg,2018,13(1):69.DOI:10.1186/s13019-018-0756-z.
[8] Zhang C,Ou YQ,Zhuang J,et al.Comparison of sutureless and conventional techniques to repair total anomalous pulmonary venous connection[J].Semin Thorac Cardiovasc Surg,2016,28(2):473-484.DOI:10.1053/j.semtcvs.2016.05.009.
[9] Seale AN,Uemura H,Sethia B,et al.Total anomalous pulmonary venous connection to the supradiaphragmatic inferior vena cava[J].Ann Thorac Surg,2008,85(3):1089-1092.DOI:10.1016/j.athoracsur.2007.08.045.
[10] 李晓峰,罗丹东,朱卫中,等.延迟关胸在新生儿先天性心脏病术后的应用[J].中华胸心血管外科杂志,2016,32(5):257-260.DOI:10.3760/cma.j.issn.1001-4497.2016.05.001. Li XF,Luo DD,Zhu WZ,et al.Application of delayed sternal closure after neonatal cardiac surgery[J].Chin J Thorac Cardiovasc Surg,2016,32(5):257-260.DOI:10.3760/cma.j.issn.1001-4497.2016.05.001.
[11] 习林云,吴春,潘征夏,等.小左心室对新生儿完全性肺静脉异位引流术后早期治疗效果的影响[J].中华小儿外科杂志,2019,40(3):203-207.DOI:10.3760/cma.j.issn.0253-3006.2019.03.003. Xi LY,Wu C,Pan ZX,et al.Impacts of left heart function for neonates with total anomalous pulmonary venous connection[J].Chin J Pediatr Surg,2019,40(3):203-207.DOI:10.3760/cma.j.issn.0253-3006.2019.03.003.
[12] Kelle AM,Backer CL,Gossett JG,et al.Total anomalous pulmonary venous connection:Results of surgical repair of 100 patients at a single institution[J].J Thorac Cardiovasc Surg,2010,139(6):1387-1394.e3.DOI:10.1016/j.jtcvs.2010.02.024.
[13] Alsoufi B.Modified primary sutureless repair technique of total anomalous pulmonary venous connection[J].World J Pediatr Congenit Heart Surg,2014,5(2):302-305.DOI:10.1177/2150135113519452.
[14] White BR,Ho DY,Faerber JA,et al.Repair of total anomalous pulmonary venous connection:risk factors for postoperative obstruction[J].Ann Thorac Surg,2019,108(1):122-129.DOI:10.1016/j.athoracsur.2019.02.017.
Memo
收稿日期:2022-4-24。
基金项目:浙江省自然科学基金(LY20H150012);浙江省医药卫生重大科技计划(WKJ-ZJ-1523)
通讯作者:舒强,Email:shuqiang@zju.edu.cn