Partial Anomalous Pulmonary Venous Connection Draining into Superior Vena Cava-Two Cases Reports

肺靜脈回流異常在心房中膈缺損(ASD)的病人是一種常見的先天性異常，尤其在sinus venosus ASD的病人中更多見。部份肺靜脈回流異常(PAPVC)的發生比例在一般民眾約0.7%，但在ASD的病人中可達10%。在這個報告裡，我們將發表二例初診斷為sinus venosus ASD及secundum ASD的病例。第一個病例同時發現有PAPVC注入上腔靜脈(SVC)，而第二個病例在心道管檢查中也懷疑有同樣的先天性異常存在，但無法以經食道超音波獲得證實。為了避免複雜的先天性心臟異常造成的開刀上的困難，開刀術式的選擇是以正中微小傷口切開術取代另一種乳房下切開術並合併全正中胸骨切開術來進行ASD的矯治。二病例在開刀中都證實有合併PAPVC注入高位上腔靜脈的情形。 ASD的開刀是心臟外科領域中最基礎的手術，而且常是年輕醫師做為微創手術的選擇。如果我們祇單純診斷為ASD而且以乳房下微創手術來進行開刀，那麼在開刀中我們將面臨很大的問題。因此，經過這二例的經驗後，我們的ASD微創手術都以正中切開術來進行，如此在有必要時，我們就可以很容易地將傷口擴大。

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並列摘要

Anomalous pulmonary venous connection is a relatively common associated anomaly in patients with atrial septal defect (ASD), particularly among those with the sinus venosus type. The incidence of partial anomalous pulmonary venous connection (P APVC) is hi2her than 0.7% in the general population and 10% in patients with ASD. In this study, we present two cases with initial impression of ASD, the sinus venosus type in one and the secundum type in the other. The one with the sinus venosus type was found to have a P APVC that drained into SVC, and the other was suspected of having the same problem because an abnormal shunt was found during cardiac catheterization. This speculation could not he proved, however, due to transesophageal echocardiogram failure. Because we feared the possibility of cardiac defects other than ASD, we performed a minimally invasive operation using a small midline incision instead of the submammary incision and did a full median sternotomy on the patient to look for other complicating coexistent cadiac defects. This patient and the former one were both proven intraoperatively to have a P APVC that drained into SVC with sinus venosus ASD. The operation to correct an ASD is a rudimentary procedure, and it often becomes a common type of minimally invasive operation among young cardiac surgeons with limited experience. A submammary incision under the impression of simple ASD may meet with certain complications. Therefore, after our experience with the latter case, we do the minimally invasive operation using a small midline incision, which can be easily extended if need be.

並列關鍵字

sinus venosus ASD ； PAPVC ； minimal invasive operation

國際替代計量

Partial Anomalous Pulmonary Venous Connection Draining into Superior Vena Cava-Two Cases Reports

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