Kramer H H, Rammos S, Krian A, Krogmann O, Ostermeyer J, Korbmacher B, Buhl R
Department of Pediatric Cardiology, Heinrich-Heine University, Düsseldorf, Germany.
Int J Cardiol. 1992 Jul;36(1):13-22. doi: 10.1016/0167-5273(92)90103-a.
We prospectively evaluated 49 consecutive hospital survivors of the arterial switch operation for complete transposition and intact ventricular septum by clinical examination, echocardiography, cardiac catheterization, 12-lead and 24-h Holter ECG. The mean length of follow-up was 40 +/- 18 months. Forty-six children are clinically asymptomatic without medication, 2 died due to coronary related left ventricular dysfunction 3 and 12 months after surgery, and 1 required reoperation because of severe bilateral pulmonary branch stenoses. Except for this case, cardiac catheterization (n = 23) revealed a mean gradient of only 17 +/- 8 mmHg between the right ventricle and distal pulmonary arteries. Left ventricular end-diastolic volume was within normal limits except for 2 cases with volumes slightly below normal, the mean ejection fraction was 78 +/- 5%, and end-diastolic and end-systolic ventricular shapes were normal. The mean cardiac index was 4.14 +/- 0.69 l/min/m2. Left ventricular end-systolic wall stress to velocity of fiber shortening relation was normal in all cases examined (n = 15), indicating normal myocardial contractility. Significant neoaortic valve insufficiency was never observed despite considerably enlarged aortic roots. Twenty-four-hour Holter ECG records (n = 46) provided no evidence of serious atrial arrhythmias, especially sinus node dysfunction. These encouraging intermediate-term results make the arterial switch operation the treatment of choice at present, for neonates with simple transposition.
我们通过临床检查、超声心动图、心导管检查、12导联和24小时动态心电图，对49例接受动脉调转术治疗完全性大动脉转位且室间隔完整的连续住院幸存者进行了前瞻性评估。平均随访时间为40±18个月。46名儿童临床无症状，无需药物治疗，2例分别在术后3个月和12个月因冠状动脉相关的左心室功能障碍死亡，1例因严重双侧肺分支狭窄需要再次手术。除该病例外，心导管检查（n = 23）显示右心室与远端肺动脉之间的平均压差仅为17±8 mmHg。除2例容积略低于正常范围外，左心室舒张末期容积在正常范围内，平均射血分数为78±5%，舒张末期和收缩末期心室形态正常。平均心脏指数为4.14±0.69 l/min/m²。在所有检查病例（n = 15）中，左心室收缩末期壁应力与纤维缩短速度的关系均正常，表明心肌收缩力正常。尽管主动脉根部明显扩大，但从未观察到明显的新主动脉瓣关闭不全。24小时动态心电图记录（n = 46）未发现严重房性心律失常的证据，尤其是窦房结功能障碍。这些令人鼓舞的中期结果使动脉调转术成为目前治疗单纯性大动脉转位新生儿的首选治疗方法。
