Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Surgical Correction of Total Anomalous Pulmonary Venous Connection without Total Circulatory Arrest

완전 순환 정지 없이 시행한 총 폐정맥 환류 이상의 수술 교정

  • Han Won Kyung (Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital) ;
  • Cho Joon Yong (Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital) ;
  • Lee Jong Tae (Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital) ;
  • Kim Kyu Tae (Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital) ;
  • Chang Bong Hyun (Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital) ;
  • Lee Eung Bae (Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital)
  • 한원경 (경북대학교병원 흉부외과) ;
  • 조준용 (경북대학교병원 흉부외과) ;
  • 이종태 (경북대학교병원 흉부외과) ;
  • 김규태 (경북대학교병원 흉부외과) ;
  • 장봉현 (경북대학교병원 흉부외과) ;
  • 이응배 (경북대학교병원 흉부외과)
  • Published : 2006.01.01
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Abstract

Background: Circulatory arrest under deep hypothermia is an important auxiliary means for surgical correction of total anomalous pulmonary venous connection (TAPVC), However, cardiac operations under deep hypothermic circulatory arrest are associated with the risk of post-arrest neurologic abnormalities. The purpose of this study is to evaluate the results of the surgical correction of total anomalous pulmonary venous connection without the total circulatory arrest. Materiai and Method: Between April 2000 and October 2004, hospital records of 10 patients were reviewed retrospectively. Result: The locations for abnormal anatomical connections were supracardiac in 7 cases, cardiac in 1 case, and infracardiac in 2 cases. The mean cardiopulmonary bypass time and aorta cross clamp time were 116.8$\pm$40.7 and 69.5$\pm$24.1 minutes. There was no surgical mortality. Postoperative complications were post-repair pulmonary venous stenosis in 1 case, pneumonia in 1, pneumothorax in 1, wound infection in 1,and diaphragmatic paralysis in 1. All patients without pulmonary venous stenosis were in NYHA class I at mean follow-up of 16.6 months (3$\∼$49 months) Conclusion: We could obtain excellent results by repair without the total circulatory arrest for total anomalous pulmonary venous connection.

배경: 초 저체온 하 순환 정지는 총 폐정맥 환류 이상을 수술하는데 있어 중요한 보조 수단이다. 그러나 초 저체온 하 순환 정지 하에 심장 수술을 하는 것은 순환 정지 후 신경계 이상의 위험을 동반하고 있다. 이에 완전 순환 정지 없이 총 폐정맥 환류 이상을 수술하여 그 결과를 평가하고자 한다. 대상 및 방법: 2000년 4월에서 2004년 10월까지 10명의 환자의 의무 기록을 후향적으로 분석하였다. 결과: 해부학적 연결 이상의 위치는 심장 상부형이 7예,심장형이 1예, 심장 하부형이 2예였다. 평균 심폐기 가동 시간과 대동맥 차단 시간은 각각 116.8 $\pm$40.7분, 69.5$\pm$24.1분이었다. 수술로 인한 사망 예는 없었고, 합병증은 술 후 폐정맥 협착이 1예, 폐렴, 기흉, 창상 감염, 횡격막 마비가 각각 1예씩 있었다. 평균 16.6개월의 추적 관찰 기간동안 페동맥 협착이 없었던 모든 환아는 NYHA class I으로 지내고 있다. 결론: 총 폐정맥 환류 이상을 완전 순환 정지 없이 수술하여 아주 만족할 만한 결과를 얻을 수 있었다.

Keywords

References

  1. Kirklin JW, Barratt-Boyes BG. Total anomalous pulmonary venous connection. In: Kouchoukos NT, Blackstone EH, Doty DB, Hanley FL, Karp RB. Cardiac surgery. 3rd ed. Philadelphia: Elsevier Science Publishing Co. 2003;753-79
  2. Muller WH. The surgical treatment of transposition of the pulmonary veins. Ann Surg 1951;134:683-99 https://doi.org/10.1097/00000658-195113440-00015
  3. Sung SC, Bang JH, Jun HJ, et al. Surgical correction of total anomalous pulmonary venous connection in early infancy. Korean J Thorac Cardiovasc Surg 1999;32:510-7
  4. Won TH, Kim YJ, Rho JR, Suh KP. Long-term results following surgical repair of total anomalous pulmonary venous return. Korean J Thorac Cardiovasc Surg 1995;28: 565-70
  5. Hancock Friesen CL, Zurakowski D, Thiagarajan RR, et al. Total anomalous pulmonary venous connection: An analysis of current management stratagies in a single institution. Ann Thorac Surg 2005;79:596-606 https://doi.org/10.1016/j.athoracsur.2004.07.005
  6. Wypij D, Newburger JW, Rappaport LA, et al. The effect of duration of deep hypothermic circulatory arrest in infant heart surgery on late neurodevelopment: The Boston circulatory arrest trial. J Thorac Cardiovasc Surg 2003;126:1397-403 https://doi.org/10.1016/S0022-5223(03)00940-1
  7. Park KH, Jun TG, Chee HK, et al. Evaluation of neurologic abnormalities after deep hypothermic circulatory arrest for pediatric cardiac surgery. Korean J Thorac Cardiovasc Surg 1996;29:14-23
  8. Shen I, giacomuzzi C, Ungerleider RM. Current strategies for optimizing the use of cardiopulmonary bypass in neonates and infants. Ann Thorac Surg 2003;75:S729-34 https://doi.org/10.1016/S0003-4975(02)04697-0
  9. Pesonen EJ, Peltola KI, Korpela RE, et al. Delayed impairment of cerebral oxygenation after deep hypothermic circulatory arrest in children. Ann Thorac Surg 1999;67:1765-70 https://doi.org/10.1016/S0003-4975(99)00320-3
  10. Wilson jr WR, Ilbawi MN, DeLeon SY, et al. Technical modifications for improved results in total anomalous pulmonary venous drainage. J Thorac Cardiovasc Surg 1992;103: 861-70
  11. Kirshbom PM, Myung RJ, Gaynor JW, et al. Preoperative pulmonary venous obstruction affects long-term outcome for survivors of total anomalous pulmonary venous connection repair. Ann Thorac Surg 2002;75:1616-20
  12. Caldarone CA, Najm HK, Kadletz M, et al. Surgical management of total anomalous pulmonary venous drainage: Impact of coexisting cardiac anomalies. Ann Thorac Surg 1998; 66:1521-6 https://doi.org/10.1016/S0003-4975(98)00951-5
  13. Lacour-Gayet F, Zoghbi J, Serraf AE, et al. Surgical management of progressive pulmonary venous obstruction after repair of total anamalous pulmonary venous connection. J Thorac Cardiovasc Surg 1999;117:679-87 https://doi.org/10.1016/S0022-5223(99)70287-4
  14. Caldarone CA, Najm HK, Kadletz M, et al. Rentless pulmonary vein stenosis after repair of total anomalous pulmonary venous drainage. Ann Thorac Surg 1998;66:1514-20 https://doi.org/10.1016/S0003-4975(98)00952-7
  15. Greeley WJ, Ungerleider RM, Smith LR, Reves JG. The effect of deep hypothermic cardiopulmonary bypass and total circulatory arrest on cerebral blood flow in infants and children. J Thorac Cardiovasc Surg 1989;97:737-45
  16. Tsui SSL, Schultz JM, Shen I, Ungerleider RM. Postoperative hypoxemia exacerbates potential brain injury after deep hypothermic circulatory arrest. Ann Thorac Surg 2003;78: 188-96 https://doi.org/10.1016/j.athoracsur.2003.11.048
  17. Smith CR, Spanier TB. Aprotinin in deep hypothermic circulatory arrest. Ann Thorac Surg 1999;68:278-86 https://doi.org/10.1016/S0003-4975(99)00518-4
  18. Langley SM, Chai PJ, Miller SE, et al. Intermittent perfusion protects the brain during deep hypothermic circulatory arrest. Ann Thorac Surg 1999;68:4-13 https://doi.org/10.1016/S0003-4975(99)00521-4
  19. Tassani P, Barankay A, Haas F, et al. Cardiac surgery with deep hypothermic circulatory arrest produces less systemic inflammatory response than low flow cardiopulmonary bypass in newborns. J Thorac Cardiovasc Surg 2002;123:648- 54 https://doi.org/10.1067/mtc.2002.121285