左冠状动脉直接再注入与从肺动脉左冠状动脉起源异常成人主动脉（ALCAPA）
Summary
ALCAPA的手术矫正强烈建议，无论年龄或intercoronary抵押的程度。该协议提出了成年型ALCAPA的直接再植入到主动脉重新建立双冠状动脉灌注的技术。只要可行，直接再注入优选其它外科手术校正技术。
Abstract
从肺动脉（ALCAPA）左冠状动脉起源异常是一种罕见的先天性异常是小儿心肌缺血和梗死的主要原因之一。如果不及时治疗，它会导致死亡率在生命的第一年90％。在谁存活到成年患者，冠状动脉偷窃现象，逆行左侧冠状动脉流量为慢性心内膜下缺血，这可能会导致左心功能不全，缺血性二尖瓣关闭不全，恶性室性心律失常和心源性猝死的基材。危及生命的表现，平均年龄为33岁，心脏性猝死31岁。因此，手术矫正高度一旦作出诊断建议，不论年龄。在成人型ALCAPA从肺动脉的右向窦起源的ALCAPA到主动脉的直接再注入是多种生理声音修复技术吨Ø重新建立双冠脉灌注系统和建议。这个协议描述成人型ALCAPA的直接再注入技术进入主动脉。
Introduction
从肺动脉（ALCAPA）左冠状动脉异常起源是一种罕见的先天性异常通常被视为分离的病变1。 ALCAPA的发生率估计为1 300000活产，0.24％和先天性心脏病2,3的0.46％之间，包括这是小儿心肌缺血和梗死的最常见的原因之一，如果不及时治疗，导致死亡率生活4的第一年90％。只有10 – 15％的婴儿存活由于大主导右冠状动脉（RCA）提供广泛的intercoronary络4的迅猛发展到成年。在新生儿期，高肺血管阻力和所得肺动脉（PA）的压力下确保顺行流从PA保持到异常左冠状动脉。由于pulmonarÿ血管阻力逐渐减小，顺行流向左冠状动脉降低。这最终导致流动的逆转，和左到右分流到PA，从而导致“冠状动脉偷5”。因此，左心室（LV）心肌灌注取决于intercoronary络从RCA 5,6。
冠状偷现象和逆行左侧冠状动脉血流提供慢性心内膜下缺血，这可能导致左心功能不全，缺血性二尖瓣反流，和由急性心肌缺血7沉淀恶性室性心律失常的基板。在成人患者的子集，在介绍的平均年龄为41岁，性别分布朝向女性患者的移位（女到男比：2：1）8。在此患者群体中，14％是无症状; 66％用本心绞痛，呼吸困难，心悸，或疲劳的症状;和现在有危及生命的症状，包括室性心律失常，晕厥和心源性猝死8 17％。危及生命的表现，平均年龄为33岁，心脏性猝死31岁8。因此，手术矫正高度只要作出诊断建议，不论年龄或intercoronary抵押1,9的程度。
根据异常左冠状动脉起源的ALCAPA进入主动脉的直接再植入是多种生理声音修复技术重建双冠状动脉灌注系统。最常见地，从ALCAPA右侧肺窦（PA的窦1），其面向主动脉窦其中主左冠状动脉通常起源（主动脉窦2）10 <起飞/ SUP>。这冠状动脉解剖是最适合于直接再注入技术。本报告的目的是描述，详细，对于成人患者在ALCAPA左冠状动脉的直接再植入技术。后面直接再注入的理由是优势-双冠状动脉的生理重建灌注它提供了一个在异常左冠状动脉与冠状动脉旁路移植11，12，13结合的结扎。
Protocol
Representative Results
Discussion
这个协议描述了ALCAPA的直接再植入到主动脉与主左冠状动脉从根据道奇-哈塔米分类10中的肺动脉的右向窦起源成年患者的详细技术。心肌保护策略和肺动脉重建都清楚地证明。这个技术的主要关键步骤是通过左冠状动脉的慷慨动员表示实现无张力的吻合术。
长时间去饱和冠状动脉灌注容忍到成年期在少数个人。谁生存本到成年的临床表现的光谱，从没有症?…
Offenlegungen
The authors have nothing to disclose.
Acknowledgements
这项工作是由瑞士心血管基金会RT的资助。
Materials
| Heart surgery infrastructure: | ||
| Heart Lung Machine | Stockert | SIII |
| EOPA 24Fr. arterial cannula | Medtronic | 77624 |
| Quickdraw 25Fr. femoral venous cannula | Edwards | QD25 |
| LV vent catheter 17Fr. | Edwards | E061 |
| Antegrade 9Fr. cardioplegia cannula | Edwards | AR012V |
| Retrograde 14Fr. cardioplegia cannula | Edwards | NPC014 |
| Electrocautery | Covidien | Force FX |
| Name | Company | Catalog number |
| Sutures: | ||
| Polypropylene 4/0 | Ethicon | 8871H |
| Polypropylene 5/0 | Ethicon | 8870H |
| Polypropylene 6/0 | Ethicon | EH7400H |
| Braided polyesther 2/0 ligature with polybutylate coating | Ethicon | X305H |
| Intergard dacron graft 8 mm | Maquet | IGW0008-30 |
| Micro knife Sharpoint | TYCO Healthcare PTY | 78-6900 |
| Name | Company | Catalog number |
| Drugs: | ||
| Midazolam | Roche Pharma | N05CD08 |
| Rocuronium | MSD Merck Sharp & Dohme | M03AC09 |
| Propofol | Fresenius Kabi | N01AX10 |
| Fentanil | Actavis | N01AH01 |
| Name | Company | Catalog number |
| Instruments: | ||
| Cooley Derra anastomosis clamp | Delacroix-Chevalier | DC40810-16 |
| Cooley vascular clamp | Delacroix-Chevalier | DC40810-16 |
| Dissection forceps Carpentier | Delacroix-Chevalier | DC13110-28 |
| Scissors Metzenbaum | Delacroix-Chevalier | B351751 |
| Needle holder Ryder | Delacroix-Chevalier | DC51130-20 |
| Dissection forceps DeBakey | Delacroix-Chevalier | DC12000-21 |
| Micro needle holder Jacobson | Delacroix-Chevalier | DC50002-21 |
| Micro scisors Jacobson | Delacroix-Chevalier | DC20057-21 |
| Lung retractor | Delacroix-Chevalier | B803990 |
| Allis clamp | Delacroix-Chevalier | DC45907-25 |
| O’Shaugnessy Dissector | Delacroix-Chevalier | B60650 |
| Vessel loop | Medline | VLMINY |
| 18 blade knife | Delacroix-Chevalier | B130180 |
| Leriche haemostatic clamp | Delacroix-Chevalier | B86555 |
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