Murthy Kona Samba, Coelho Robert, Kulkarni Snehal, Ninan Benjamin, Cherian Kotturathu Mammen
Department of Paediatric Cardiac Surgery, Institute of Cardiovascular Diseases, 4a Dr J.J. Nagar, Mogappair, 600 050, Chennai, India.
Eur J Cardiothorac Surg. 2004 Feb;25(2):246-9. doi: 10.1016/j.ejcts.2003.10.022.
Transposition of great arteries (TGA) with single coronary artery pattern is one of the high-risk groups for arterial switch operation (ASO). Any traction or kinking during coronary transfer can lead to a fatal outcome. With increase in experience, surgical results improved, but it did not completely eliminate the risks of coronary translocation. Many techniques have been described for transfer of single coronary and each one has its own merits and problems. We here in describe a new technique of in situ coronary reallocation during ASO for TGA with single coronary and also report the early and mid-term results with this new technique.
From September 1988 to June 2002, five consecutive cases of TGA with single coronary artery were operated employing this new technique. Their age ranged from 16 days to 9 months. ASO was done by transecting the great arteries just above the commissures. For coronary reallocation, hockey stick-shaped incisions were made in the facing sinuses of the proximal aorta and the pulmonary artery. These flaps were sutured in such a way that the coronary ostium was committed to the neo-aorta with the rest of surgical procedure done in the usual manner.
All five patients had ASO. Additionally, four patients had closure of an associated ventricular septal defect and one patient had repair of the coarctation of the aorta. There was no in hospital mortality. All patients had follow-up echocardiograms at regular intervals, which showed no significant right or left ventricular outflow obstruction, no regional wall motion abnormalities and no neo-aortic or neo-pulmonary regurgitation. Three of five patients had cardiac catheterization and angiocardiography, which showed normal coronary arteries with no obstructive lesions and no neo-aortic regurgitation. Their follow up ranged from 5 to 50 months and there was no late mortality.
This new coronary reallocation technique avoids problems related to coronary translocation such as traction and kinking. It spares the need for dissection of proximal coronary artery and its branches, and thereby eliminates the risk of development of fibrosis and stenosis. The same technique can be used regardless of the sinus of origin of the coronary artery. It is a reliable and a reproducible technique. The early and mid-term results appear excellent in this series.
具有单一冠状动脉形态的大动脉转位（TGA）是动脉调转手术（ASO）的高危群体之一。冠状动脉转移过程中的任何牵拉或扭曲都可能导致致命后果。随着经验的增加，手术结果有所改善，但并未完全消除冠状动脉移位的风险。已经描述了许多用于单一冠状动脉转移的技术，每种技术都有其自身的优点和问题。我们在此描述一种在ASO期间对具有单一冠状动脉的TGA进行原位冠状动脉重新定位的新技术，并报告使用该新技术的早期和中期结果。
从1988年9月至2002年6月，连续5例具有单一冠状动脉的TGA患者采用了这种新技术进行手术。他们的年龄从16天到9个月不等。ASO通过在瓣叶上方横断大动脉来完成。对于冠状动脉重新定位，在近端主动脉和肺动脉相对的窦部做曲棍球棒状切口。这些瓣片以这样的方式缝合，即冠状动脉口与新主动脉相连，其余手术步骤按常规方式进行。
所有5例患者均接受了ASO。此外，4例患者关闭了相关的室间隔缺损，1例患者修复了主动脉缩窄。无住院死亡病例。所有患者定期进行超声心动图随访，结果显示无明显的右或左心室流出道梗阻、无节段性室壁运动异常、无新主动脉或新肺动脉反流。5例患者中有3例进行了心导管检查和心血管造影，结果显示冠状动脉正常，无阻塞性病变，无新主动脉反流。他们的随访时间为5至50个月，无晚期死亡病例。
这种新的冠状动脉重新定位技术避免了与冠状动脉移位相关的问题，如牵拉和扭曲。它无需解剖近端冠状动脉及其分支，从而消除了纤维化和狭窄形成的风险。无论冠状动脉起源于哪个窦部，均可使用相同的技术。这是一种可靠且可重复的技术。该系列的早期和中期结果似乎非常出色。
