三种手术矫治静脉窦型房间隔缺损的临床结果_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 陈仁伟 ^1,2 , 罗金文 ¹ , 阳广贤 ¹ , 邓喜成 ¹ , 黄鹏 ¹

1. ;
2. ;

Corresponding author：

陈仁伟, Email: chenrenwei@sina.com

Keywords：

静脉窦型房间隔缺损; 肺静脉异位连接; Warden 手术

DOI：

10.7507/1007-4848.201712004

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目的总结静脉窦型房间隔缺损（SVASD）合并部分性肺静脉异位连接（PAPVC）外科治疗的临床结果。方法回顾性分析 2000 年 1 月至 2016 年 12 月湖南省儿童医院 49 例 SVASD/PAPVC 患者的临床资料，其中男 21 例、女 28 例，年龄 5 个月～14 岁，平均年龄（4.7±2.1）岁。肺静脉异位连接位置位于右房者 9 例，位于右房与上腔静脉连接部者 12 例，位于上腔静脉者 28 例。根据手术方式分为三组，A 组 29 例采用单片心包补片修补，B 组 12 例采用双片心包补片修补，C 组 8 例将上腔静脉近心端引入左房、上腔静脉远心端与右心耳吻合（Warden 手术）进行矫治。结果手术效果满意，心内无残余分流，无手术死亡病例，无再手术者，无肺静脉回流梗阻病例出现。随访 6 个月至 15 年，术后 7 例上腔静脉流速增高，其中 A 组 4 例（13.8%），B 组 2 例（9.5%），C 组 1 例（12.5%）。术后 7 例窦房结功能异常，其中 A 组 3 例（10.3%，随访恢复窦性心律），B 组 4 例（19.0%，随访时 3 例恢复窦性心律，1 例为结性心律），C 组无窦房结功能异常病例出现。结论 SVASD 多伴有右侧肺静脉异位连接，矫正 SVASD 时应注意防止上腔静脉和右侧肺静脉回流梗阻，并避免影响窦房结功能，选择适当的手术方式可以减少并发症的发生。Warden 手术能有效避免窦房结功能的影响，对于异位连接位置位于上腔静脉高位者，Warden 法应作为首选。

Citation： 陈仁伟, 罗金文, 阳广贤, 邓喜成, 黄鹏. 三种手术矫治静脉窦型房间隔缺损的临床结果. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(11): 1012-1014. doi: 10.7507/1007-4848.201712004 Copy

1.	Park CS, Kwak JG, Lee C, et al. Partial anomalous pulmonary venous connection to the superior vena cava: the outcome after the Warden procedure. Eur J Cardiothorac Surg, 2012, 41(2): 261-265.
2.	Said SM, Burkhart HM, Dearani JA, et al. Outcome of caval division techniques for partial anomalous pulmonary venous connections to the superior vena cava. Ann Thorac Surg, 2011, 92(3): 980-985.
3.	Warden HE, Gustafson RA, Tarnay TJ, et al. An alternative method for repair of partial anomalous pulmonary venous connection to the superior vena cava. Ann Thorac Surg, 1984, 38(6): 601-605.
4.	朱宏斌, 张海波, 徐志伟, 等. 静脉窦型房间隔缺损的外科治疗. 中国胸心血管外科临床杂志, 2006, 13(2): 86-88.
5.	李世国, 蒋世良, 吕滨, 等. 上腔静脉窦型房间隔缺损的多层螺旋 CT 诊断. 中华放射学杂志, 2012, 48(6): 508-511.
6.	Ling Y, Gan C, Sandeep B, et al. Modified Warden procedure for partial anomalous pulmonary venous return to the superior vena cava. J Card Surg, 2016, 31(10): 631-634.
7.	Iyer AP, Somanrema K, Pathak S, et al. Comparative study of single- and double-patch techniques for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection. J Thorac Cardiovasc Surg, 2007, 133(3): 656-659.
8.	Shahriari A, Rodefeld MD, Turrentine MW, et al. Caval division technique for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection. Ann Thorac Surg, 2006, 81(1): 224-229.
9.	Hofmann M, Dave HH, Schmiady MO, et al. Warden procedure for correction of sinus venosus atrial septal defect and partial anomalous pulmonary venous connection. Multimed Man Cardiothorac Surg, 2016: 2016.
10.	Kim C, Cho YH, Lee M, et al. Surgery for partial anomalous pulmonary venous connections: modification of the warden procedure with a right atrial appendage flap. Korean J Thorac Cardiovasc Surg, 2014, 47(2): 94-99.
11.	Ramanan S, Sasikumar N, Manohar SR, et al. The warden procedure through a posterolateral thoracotomy approach. Tex Heart Inst J, 2014, 41(5): 499-501.
12.	Zubritskiy A, Arkhipov A, Khapaev T, et al. The Warden procedure can be successfully performed using minimally invasive cardiac surgery without aortic clamping. Interact Cardiovasc Thorac Surg, 2016, 22(2): 225-227.

1. Park CS, Kwak JG, Lee C, et al. Partial anomalous pulmonary venous connection to the superior vena cava: the outcome after the Warden procedure. Eur J Cardiothorac Surg, 2012, 41(2): 261-265.
2. Said SM, Burkhart HM, Dearani JA, et al. Outcome of caval division techniques for partial anomalous pulmonary venous connections to the superior vena cava. Ann Thorac Surg, 2011, 92(3): 980-985.
3. Warden HE, Gustafson RA, Tarnay TJ, et al. An alternative method for repair of partial anomalous pulmonary venous connection to the superior vena cava. Ann Thorac Surg, 1984, 38(6): 601-605.
4. 朱宏斌, 张海波, 徐志伟, 等. 静脉窦型房间隔缺损的外科治疗. 中国胸心血管外科临床杂志, 2006, 13(2): 86-88.
5. 李世国, 蒋世良, 吕滨, 等. 上腔静脉窦型房间隔缺损的多层螺旋 CT 诊断. 中华放射学杂志, 2012, 48(6): 508-511.
6. Ling Y, Gan C, Sandeep B, et al. Modified Warden procedure for partial anomalous pulmonary venous return to the superior vena cava. J Card Surg, 2016, 31(10): 631-634.
7. Iyer AP, Somanrema K, Pathak S, et al. Comparative study of single- and double-patch techniques for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection. J Thorac Cardiovasc Surg, 2007, 133(3): 656-659.
8. Shahriari A, Rodefeld MD, Turrentine MW, et al. Caval division technique for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection. Ann Thorac Surg, 2006, 81(1): 224-229.
9. Hofmann M, Dave HH, Schmiady MO, et al. Warden procedure for correction of sinus venosus atrial septal defect and partial anomalous pulmonary venous connection. Multimed Man Cardiothorac Surg, 2016: 2016.
10. Kim C, Cho YH, Lee M, et al. Surgery for partial anomalous pulmonary venous connections: modification of the warden procedure with a right atrial appendage flap. Korean J Thorac Cardiovasc Surg, 2014, 47(2): 94-99.
11. Ramanan S, Sasikumar N, Manohar SR, et al. The warden procedure through a posterolateral thoracotomy approach. Tex Heart Inst J, 2014, 41(5): 499-501.
12. Zubritskiy A, Arkhipov A, Khapaev T, et al. The Warden procedure can be successfully performed using minimally invasive cardiac surgery without aortic clamping. Interact Cardiovasc Thorac Surg, 2016, 22(2): 225-227.

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三种手术矫治静脉窦型房间隔缺损的临床结果

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