Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Partial Anomalous Pulmonary Venous Connection to the Superior Vena Cava

  • Lee, Sub (Department of Thoracic and Cardiovascular Surgery, Schoole of Medicine, Catholic University of Daegu) ;
  • Kim, Han-Woong (Department of Cardiovascular Surgery, Sejong Heart Institute, Sejong General Hospital) ;
  • Kang, Hyoung-Seok (Department of Thoracic and Cardiovascular Surgery, Schoole of Medicine, Catholic University of Daegu) ;
  • Bae, Chi-Hoon (Department of Thoracic and Cardiovascular Surgery, Schoole of Medicine, Catholic University of Daegu) ;
  • Jheon, Sang-Hoon (Department of Thoracic and Cardiovascular Surgery, Schoole of Medicine, Catholic University of Daegu) ;
  • Kwon, Oh-Choon (Department of Thoracic and Cardiovascular Surgery, Schoole of Medicine, Catholic University of Daegu) ;
  • Ahn, Wook-Su (Department of Thoracic and Cardiovascular Surgery, Schoole of Medicine, Catholic University of Daegu)
  • 이섭 (대구가톨릭대학병원 흉부외과) ;
  • 김웅한 (세종병원 흉부외과) ;
  • 강형석 (대구가톨릭대학병원 흉부외과) ;
  • 배지훈 (대구가톨릭대학병원 흉부외과) ;
  • 전상훈 (대구가톨릭대학병원 흉부외과) ;
  • 권오준 (대구가톨릭대학병원 흉부외과) ;
  • 안욱수 (대구가톨릭대학병원 흉부외과)
  • Published : 2001.09.01
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Abstract

Background: Surgical correction of partial anomalous pulmonary venous connection to the superior vena cava has been associated with postoperative venous obstruction and sinus node dysfunction. In this paper we describe our current approach and its short-term results. Material and Method: Between April 1999 and January 2000, 5 consecutive patients, ranging from 2 months to 66 years old, underwent corrective operation for partial anomalous pulmonary venous connection to the superior vena cava at Sejong General Hospital and Daegu Catholic University Medical Center. Surgical correction involved diversion of the pulmonary venous drainage to the left atrium using a right atrial flap(2 patients) or prosthetic patch(3 patients) with division of the superior vena cava superior to the restore site of the pulmonary veins and reimplantation on the right atrial appendage to restore systemic venous drainage. Result: All patients were discharged between postoperative day 9 and 15 without complications. One Russian boy returned to his country, therefore, he was lost to follow-up after discharge. Remaining 4 patients were asymptomatic and in normal regular sinus rhythm at a mean follow-up of 17.75$\pm$4.27 months. Follow-up echocardiographic study (range, 12 to 24 months) revealed no incidence of narrowing of the venous pathways or of residual shunt. Conclusion: Our current approach is relatively simple and reproducible in achieving unobstructive pulmonay venous and SVC pathways. By avoiding incision across the cavoatrial junction, surgical injury to the sinus node and its artery may be minimized. The presented surgical technique can be safely and effectively applied to the selected patients.

배경: 폐정맥 및 상대정맥의 폐쇄와 동방결절의 기능장애 등은 상대정맥으로 환류되는 부분폐정맥 연결이상의 수술교정 이후 발생할 수 있는 합병증으로 술 후 정기성적을 결정하는 요인이 되어왔다. 저자들이 시행하고 있는 수술방법을 기술하고 조기결과를 분석하였다. 대상 및 방법: 1999년 4월부터 2000년 1월까지 세종병원과 대구가톨릭대학병원에서 5명의 환자가 상대정맥으로 환류되는 부분폐정맥 연결이상으로 교정수술을 받았다. 환자의 나이는 생후 2개월부터 66세까지였다. 수술방법은 우심방 피판(2례)이나 첨포(3례)를 사용하여 이상폐정맥을 심방간 통로를 통하여 좌심방으로 정상환류시키고, 상대정맥을 이상폐정맥의 상부에서 절단한 후 근위부를 폐쇄하고 상대정맥의 원위부를 우심방이에 단단문합함으로써 상대정맥과 우심방의 혈류를 재건하였다. 결과: 모든 환자가 합병증 없이 술 후 9일과 15일 사이에 퇴원하였다. 퇴원 후 본국으로 돌아간 러시아 환아를 제외한 4명의 환자는 평균 17.75$\pm$4.27 개월의 추적기간 동안 증상 없이 정상동율동을 보였다. 술후 12개월에서 24개월에 시행한 심장초음파검사상 폐정맥이나 상대정맥의 협착 및 잔류단락은 보이지 않았다. 결론: 저자들은 상대정맥으로 환류되는 부분폐정맥 연결이상 환자에서 기술한 수술방법으로 폐정맥 및 상대정맥 혈류의 협착 없이 좋은 결과를 얻을 수 있었다. 상대정맥과 우심방접합부위를 가로지르는 절개를 피함으로써 동방결절 및 그 동맥의 손상을 최소화 할 수 있을 것으로 생각된다.

Keywords

References

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