Objective To summarize the experience of the surgical treatment of total anomalous pulmonary venous connection (TAPVC) in 31 cases，so as to elevate the operative effect. Methods The total corrected operation under moderate hypothermic cardiopulmonary bypass were performed in 31 cases with TAPVC. Site of drainage was supracardiac (n=16),cardiac(n=13)and mixed(n=2). Other accompanying congenital cardiac malformations were diagnosed such as atrial septal defect(n=31), patent ductus arteriosus(n=4), pulmonic stenosis(n=1), mitral regurgitation(n=1), tricuspid regurgitation (n=15)，etc. Results No hospital death was observed in the early period of operation (30 d). Complication occurred in 8 cases (25.8%), such as paroxysm of nodal rhythm(n=1), Ⅰ° atrial ventricular block(n=1), frequently atrial premature beats and paroxysm of auricular tachycardia(n=1),pulmonary infection(n=2),atelectasis(n=1), pneumatothorax (n=1), left diaphragmatic paralysis and pulmonary infection with tracheal reintubation (n=1),etc. All of them discharged after active therapy. All of 31 cases was followed up, followup time was 2.8±1.5 years. 30 cases were living (96.7%) and 1 case died of heart failure 8 months after operation. 2 cases had auricular arrhythmia with a bad medical effect. 28 cases(93.3%) had normal heart function and they could work and live normally after discharged. Conclusion Surgical procedure should be based on individual abnormality for TAPVC.Surgeons should take care not only of the stenosis of anastomotic stoma,but also of the arrhythmia after operation.Satisfied correction of the abnormality is important and the curative effect of those cases is approving.
Objective To summarize the surgical experience of supracardiac total anomalous pulmonary venous connection(S-TAPVC) and study the surgical technique and outcomes for S -TAPVC. Methods Eightysix patients with S-TAPVC underwent the surgical repair from May 1985 to December 2007. There were 49 males and 37 females. The patients aged from 7 months to 35 years (mean 9.6 years) and weighed from 4.9 kg to 68.0 kg (mean 23.8 kg). The patients were divided into three groups by the approach for the anastomosis. There were 20 patients in groupⅠthrough the right atrium incision, 49 patients in group Ⅱ through the right and left atrium incisions and 17 patients in group Ⅲ through the top of the left atrium incision. The interrupt continuous anastomosis between the common pulmonary venous and the left atrium was used in all patients. The enlarged atrial septal defect(ASD) was repaired with autopericardium. The vertical vein was ligated if the postoperative left atrial pressure was less than 15 mm Hg. But the vertical vein was opened or just partialy ligated if the postoperative left atrial pressure was more than 15 mm Hg. Results There was no early operative death. The postoperative left atrial pressure in three groups were 9.3±3.2 mm Hg, 9.9±2.9 mm Hg and 11.6±3.8 mm Hg, respectively. The cases with open or just partly ligated vertical vein in three groups were 0 case （0%）, 7 cases (14.3%) and 2 cases (11.8%), respectively. The cases of arrhythmia in three groups were 5 cases （25.0％）, 15 cases （30.6%）and 1 case （5.9%）. The severely low cardiac output syndrome occurred in 2 patients and reoperation for bleeding in 2 patients. The morbidity of arrhythmia in group Ⅲ was less than in group Ⅱ（P=0.042）. Conclusion The outcome of surgical repair for S -TAPVC is satisfactory. The anastomosis through the top of the left atrium incision has low occurrence of arrhythmia. The anastomosis through the right and left atrium incision is easy to expose and to perform surgery, especial for old children and adult patients.
【摘要】 目的 探讨正常成人肺静脉开口径线（pulmonary vein ostia，PVO）的测量方法，并获得我院PVO径线值的95%参考值范围。 方法 2005年6月-2006年1月收集无明显心肺疾病的正常成人236例，对其进行多层螺旋CT扫描，利用斜冠面重建和三维标定的方法测量PVO径线。 结果 四条PVO径线的95%参考值范围如下：右上肺静脉长径线为男性1.49~2.63 cm，女性1.31~2.37 cm，短径线为男性0.87~2.05 cm，女性0.91~1.81 cm；右下肺静脉长径线为男性1.12~2.06 cm，女性1.05~1.95 cm，短径线为男性0.77~1.83 cm，女性0.79~1.69 cm；左上肺静脉长径线为男性1.18~2.20 cm，女性1.09~2.11 cm，短径线为男性0.82~1.72 cm，女性为0.80~1.62 cm；左下肺静脉长径线为男性0.96~1.98 cm，女性1.03~1.81 cm，短径线为男性0.56~1.26 cm，女性0.51~1.33 cm。除左下肺静脉短径男女差异无统计学意义外，其余径线值男性均大于女性。 结论 采用CT三维重建像改进测量方法测量PVO径线值既简便又准确。【Abstract】 Objective To measure and calculate the diameters of pulmonary vein ostia (PVO) by multi-slice spiral computed tomography (MSCT) in healthy people. Methods From June 2005 to January 2006, 236 healthy people were adopted to undergo MSCT. Their diameters of PVO were measured and calculated by oblique coronal planes reconstruction and 3D position-setting. Results Right superior vein: the 95% reference ranges of the long diameters were 1.49-2.63 cm in the male and 1.31-2.37 cm in the female;the ranges of the short diameters were 0.87-2.05 cm in the male and 0.91-1.81 cm in the female. Right inferior vein: the ranges of the long diameters were 1.12-2.06 cm in the male and 1.05-1.95 cm in the female;the ranges of the short diameters were 0.77-1.83 cm in the male and 0.79-1.69 cm in the female. Left superior vein: the ranges of the long diameters were 1.18-2.20 cm in the male and 1.09-2.11 cm in the female;the ranges of the short diameters were 0.82-1.72 cm in the male and 0.80-1.62 cm in the female. Left inferior vein: the ranges of the long diameters were 0.96-1.98 cm in the male and 1.03-1.81 cm in the female;the ranges of the short diameters were 0.56-1.26 cm in the male and 0.51-1.33 cm in the female. The diameters in the male were all longer than those in the female, except the short diameter of left inferior vein. Conclusions It is a convenient and accurate method to measure the diameters of PVO by blique coronal planes reconstruction and 3D position-setting.
ObjectiveTo investigate the influence of norepinephrine on pulmonary vessel pressure in animal model of septic shock. MethodsTwelve health mongrel dogs were randomly divided into a control group (n=5, intravenously injected with normal saline 1 mL/kg) and an endotoxin group(n=7, intravenously injected with lipopolysaccharide 1 mg/kg). When the systemic blood pressure decreased by more than 40% of baseline before administration, the dogs in two groups were intravenously injected with NE 0.5, 1.0, 2.0, 5.0μg·kg-1·min-1. The interval of each dose was more than 10 minutes. The changes of the pulmonary arterial pressure (PAP), pulmonary venous pressure (PVP), and systemic arterial rressure (SAP) were recorded and compared between two groups. ResultsIn the control group, PAP didn't change significantly after administration (P < 0.05), however, PVP increased obviously after NE administration in dose of 2.0 and 5.0μg·kg-1·min-1 (P < 0.05), and SAP increased obviously after NE administration in dose of 1.0, 2.0 and 5.0μg·kg-1·min-1 (P < 0.01). In the endotoxin group, PAP increased obviously after NE administration in dose of 2.0 and 5.0μg·kg-1·min-1 (P < 0.05), while PVP didn't change significantly (P > 0.05), and SAP increased obviously after NE administration in dose of 1.0, 2.0 and 5.0μg·kg-1·min-1 (P < 0.05). There were significant differences in SAP (P < 0.05), not in PAP and PVP (P > 0.05), between two groups after NE administration at dose of 1.0, 2.0 and 5.0μg·kg-1·min-1. The PVP/SAP and PAP/SAP values didn't change significantly after administration in the control group (P > 0.05). In the endotoxin group, the PVP/SAP and PAP/SAP values increased significantly after LPS administration, and decreased slightly after NE administration in dose of 2.0 and 5.0μg·kg-1·min-1 (P < 0.05). ConclusionsNE administration in septic shock can not increase the angiotasis of the pulmonary vein. NE administration in dose of 2.0 and 5.0μg·kg-1·min-1 can cause the increase of PAP and SAP, but the increase of PAP is lower than the increase of SAP.
ObjectiveTo analyze clinical outcomes of sutureless technique for patients undergoing surgical correction of total anomalous pulmonary venous connection (TAPVC). MethodsBetween July 2007 and December 2013, 132 consecutive TAPVC patients underwent surgical correction in Guangdong Cardiovascular Institute. Those patients with such associated congenital cardiac anomalies as single ventricle and right atrial isomerism were excluded from this study. All the patients underwent biventricular repair. Preoperatively, all the patients received echocardiography, and most patients received CT scan to know the development of pulmonary veins. Preoperative diagnosis was confirmed by intraoperative exploration. According to different surgical techniques, all the patients were divided to a conventional technique group and a sutureless technique group. In the conventional technique group, there were 69 patients including 54 males (78.3%)and 15 females (21.7%)with their median age of 60 (30, 225)days and median body weight of 4.85 (3.50, 6.35)kg. In the sutureless technique group, there were 63 patients including 48 males (76.20%)and 15 females (23.8%)with their median age of 90 (30, 210)days and median body weight of 4.58 (3.72, 6.20)kg. Follow-up was performed till January 1, 2014. ResultsIn-hospital mortality (4.8% vs. 7.2%, χ2=1.414, P=0.720)and postoperative overall mortality (4.8% vs. 13.0%, χ2=2.733, P=0.098)of the sutureless technique group were both lower than those of the conventional technique group, although there was no statistical difference. Postoperative incidence of pulmonary venous obstruction (PVO)of the sutureless technique group was significantly lower than that of the conventional technique group (1.6% vs. 10.1%, χ2=4.236, P=0.040). Cox proportional-hazards regression showed that conventional technique and preoperative PVO were significant risk factors for postoperative PVO (P=0.023, P=0.016). Conventional technique was not significantly correlated with postoperative mortality (P=0.060). ConclusionSutureless technique can significantly lower postoperative incidence of PVO for patients with supracardiac TAPVC.
Total anomalous pulmonary venous connection (TAPVC)is one of a few congenital heart diseases which need emergency surgical correction, but its high perioperative mortality remains a dilemma for its surgical correction. In recent years, increasing studies have achieved a great progress regarding risk factors of surgical mortality of TAPVC. Surgical era, anatomic classification, younger age, low body weight, long cardiopulmonary bypass time and pulmonary venous obstruction have been generally considered important risk factors of surgical mortality of TAPVC. This review focuses on domestic and international research progress of risk factors of surgical mortality of TAPVC in recent years in order to further understand their mechanisms, reduce surgical mortality as much as possible, and improve clinical outcomes.