成人型左冠状动脉起源于肺动脉的外科治疗  

Surgical treatment of adults with anomalous left coronary artery from the pulmonary artery

作　　者：苏文君[1] 杨克明[1] 王姗 吕小东[1] 闫军[1] 李守军[1] SU Wenjun;YANG Keming;WANG Shan;LV Xiaodong;YAN Jun;LI Shoujun(Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease, Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China)

机构地区：[1]中国协和医科大学中国医学科学院阜外医院心脏外科,100037

出　　处：《心肺血管病杂志》2018年第5期436-439,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家重点研发计划(2017YFC1308100)

摘　　要：目的:总结成人型左冠状动脉起源于肺动脉(ALCAPA)外科手术治疗的经验。方法:回顾性分析本院2005年l O月至2017年9月,手术治疗34例ALCAPA患者的临床资料,其中男性7例,女性27例;年龄18~63岁,平均年龄(38.4±13.5)岁。手术方法包括左冠状动脉直接移植术、肺动脉内通道术(takeuchi)、肺动脉壁卷管延长移植术(tubular extension)、冠状动脉旁路移植术(CABG)和二尖瓣成形术(MVP)。术后观察手术效果,围术期病死率和并发症发生率。结果:12例患者接受Takeuchi术,9例患者接受左冠状动脉直接移植术,10例患者接受tubular extension移植术,另3例患者接受CABG术,7例患者因二尖瓣中量或大量返流接受MVP术。体外循环时间和主动脉阻断时间分别为(144.8±65.8)min和(99.7±47.2)min。术后10例患者二尖瓣少量返流,无中量以上返流。术后左心室舒张末期内径(LVEDD)[(49.0±9.0)vs.(55.2±5.6)mm,P=0.001]及左心室射血分数(LVEF)[(61.1±7.1)%vs.(57.3±8.4)%,P=0.047]与术前相比均明显改善,差异有统计学意义,术后无严重并发症及死亡。术后随访时间6个月~12年,随访期间无患者死亡,心功能正常。结论:成人型ALCAPA经外科手术治疗后效果满意,因此。Objective： To review the experience of the surgical treatment of adult patients with anomalous left coronary artery from the pulmonary artery(ALCAPA）. Methods： We retrospectively analyzed the clinical data of 34 adult patients with ALCAPA underwent establishment of dual coronary perfusion in our hospital between 2005 and 2017. There were 7 males and 27 females at mean age of 38. 4(18-63） years old. Results： There was no death in-hospital. The mean cardiopulmonary bypass time and cross-clamp time was(144. 8± 65. 8） min and(99. 7 ± 47. 2） min,respectively. Surgical procedures included 19 cases of direct re-implantation of the coronary artery into the aorta by transferring a button of pulmonary artery or by tubular reconstruction,3 cases of ligature of the origin of the artery along with coronary artery bypass grafting,and 12 cases of the Takeuchi procedure,consisting in a transpulmonary baffle between the coronary ostium in the pulmonary artery and the aorta. The mean postoperative left ventricular ejection fraction(LVEF） [(61. 1 ± 7. 1） % vs.(57. 3 ±8. 4） %,P = 0. 047]and left ventricular end diastolic diameter(LVEDD） [(49. 0 ± 9. 0） vs.(55. 2 ± 5. 6） mm,P = 0. 001]significantly improved compared postoperative. Seven patients with moderate or severe mitral regurgitation(MR） underwent the procedure of mitral valve repair. The MR distribution was mild or trivial in 10 patients and none in 24 patients. During the follow-up period,no patient died due to cardiac reason,1 patient underwent Takeuchi procedure required reoperation for baffle leaks. All the patients survived with New York Heart Association heart function class Ⅰ or class Ⅱ. Conclusion： Surgical correction performed on ALCAPA syndrome is considered to be the standard treatment. The aim of surgery is to restore a two-coronary-artery circulation system. Mitral valve repair is recommended for the patients with severe or moderate regurgitation and evident ischemic lesions of the papillary muscles.

关 键 词：左冠状动脉起源于肺动脉 冠状动脉旁路移植术 肺动脉内通道术 

分 类 号：R54[医药卫生—心血管疾病]