小儿左冠状动脉异常起源于肺动脉的外科矫治  

Surgical treatment of anomalous left coronary artery from the pulmonary artery in children

作　　者：薛兰钢[1] 路万里[1] 刘金松 陈万兴 王秀丽[1] 李鑫 张颖[1] 黄辉 刘志刚[1] Xue Langang;Lu Wanli;Liu Jinsong;Chen Wanxing;Wang Xiuli;Li Xin;Zhang Ying;Huang Hui;Liu Zhigang(Department of Cardiovascular Surgery,TEDA International Cardiovascular Hospital,Tianjin 300457,China)

机构地区：[1]泰达国际心血管病医院心血管外科,天津300457

出　　处：《中华解剖与临床杂志》2022年第3期169-174,共6页Chinese Journal of Anatomy and Clinics

基　　金：国家重点研发计划(2016YFC1302002)。

摘　　要：目的总结小儿左冠状动脉异常起源于肺动脉(ALCAPA)的外科矫治方法及效果。方法回顾性研究。纳入2015年2月—2020年10月泰达国际心血管病医院9例接受外科手术治疗的小儿ALCAPA患者的临床资料。男2例、女7例,年龄0.2~12.3岁(中位年龄1.7岁),体质量5.7~44.3 kg(中位体质量11.6 kg)。患者采取个体化手术策略(肺动脉内隧道技术、主动脉壁和带蒂肺动脉壁缝合、带蒂直接移载、左主干开口成形术)恢复双源冠状动脉供血,其中4例同期行二尖瓣成形术。观察指标:监测患儿左心室射血分数(LVEF)和二尖瓣反流程度,并比较其在术前、术后早期、末次随访时的变化。结果全组患儿均手术顺利,无死亡。2例重症婴儿术后延迟关胸6 d和9 d。9例患儿出院后获随访1个月~4.5年,均未出现心绞痛或心力衰竭症状。患儿术后早期与术前LVEF分别为62.1%(39.0%,63.5%)和59.0%(40.0%,64.5%),差异无统计学意义(Z=14.00,P=1.000);末次随访LVEF为64.0%(60.5%,67.5%),较术后早期改善,差异有统计学意义(Z=26.50,P=0.034)。术后早期二尖瓣反流与术前、末次随访比较,差异均无统计学意义(Z=1.13、1.41,P=0.257、0.157)。结论对于小儿ALCAPA采用个性化外科矫治手术可以获得满意的近中期效果。Objective To summarize the surgical results of anomalous left coronary artery from the pulmonary artery(ALCAPA)in children.Methods A retrospective study of nine cases of pediatric ALCAPA who were admitted to TEDA International Cardiovascular Hospital between February 2015 and October 2020 was conducted.The patients included two males and seven females with a range age of 0.2-12.3 years(median 1.7 years)and a range body mass of 5.7-44.3 kg(median 11.6 kg).Patients were treated with individualized surgical strategies(Takeuchi,Flap-to-flap,Tanslocation,Ostioplasty)to restore dual-source coronary artery blood supply,4 patients underwent concomitant mitral valvuloplasty.The degree of left ventricular ejection fraction(LVEF)and mitral valve regurgitation were monitored,and changes in the two indicators were compared before surgery,in the early postoperative period,and at the last follow-up.Results All patients were operated successfully without death.Two severely infants had delayed chest closure after operation.All patients were followed up for 1 month to 4.5 years after discharge,and no angina or heart failure was found.The LVEF in the early postoperative and preoperative periods were 62.1%(39.0%,63.5%)and 59.0%(40.0%,64.5%),respectively,with no significant difference(Z=14.00,P=1.000);LVEF at the last follow-up was 64.0%(60.5%,67.5%),which was significantly improved compared with that in the early postoperative period(Z=26.50,P=0.034).Early postoperative mitral value regurgitation had no significant difference compared with preoperative and final follow-up mitral value regurgitation(Z=1.13,1.41;P=0.257,0.157).Conclusion Satisfactory short-and medium-term results can be achieved through surgery in children with ALCAPA.

关 键 词：心血管畸形 左冠状动脉起源异常 心力衰竭 二尖瓣成形术 

分 类 号：R726.5[医药卫生—儿科]