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[大动脉转位合并右心室双出口及肺动脉下室间隔缺损的动脉调转术]

[Arterial switch operation for transposition of the great arteries and double outlet of right ventricle with subpulmonary ventricular septum defect].

作者信息

Xu Zhi-wei, Ding Wen-xiang, Su Zhao-kang, Chen Ling, Shi Zhen-ying, Zhu De-ming

机构信息

Department of Thoracic and Cardiovascular Surgery, Xinhua Hospital, Shanghai Second Medical University, Shanghai 200127, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2004 Apr 22;42(8):451-4.

Abstract

OBJECTIVE

To summarize the clinical experience on the arterial switch operation for complex congenital heart disease in recent 3 years in our hospital.

METHODS

Sixty-one patients with complex congenital heart disease received by arterial switch operation from Jan 2000 to May 2003. There were 26 patients with transposition of the great arteries and intact ventricular septum (TGA-IVS), 19 patients with transposition of the great arteries and ventricular septal defect (TGA-VSD) and 16 patients with double outlet of right ventricle with subpulmonary ventricular septum defect (Taussig-Bing).

RESULTS

There were 2 death among TGA-IVS cases, 4 deaths among TGA-VSD cases and 4 deaths among Taussig-Bing cases. The total operative mortality was 16%. All patients were followed up 3 months to 3 years. In all patients, the cyanosis disappeared and the physical activities increased obviously. One patients with Taussig-Bing keep moderate mitral valve reflux unchanged, 2 patients with TGA had pulmonary and aortic supra-valve stenosis with 40 mmHg pressure gradient. One patient with subpulmonary stenosis and residual VSD was re-operated 3 months later. All survivor had good heart function.

CONCLUSIONS

The effect of arterial switch operation on the treatment of TGA was well accepted in this study. The procedure used in treatment on Taussig-Bing can prevent pulmonary obstruction and avoid the complication of left ventricular outflow tract obstruction caused by intraventricular repair.

摘要

目的

总结我院近3年复杂先天性心脏病动脉调转术的临床经验。

方法

2000年1月至2003年5月,61例复杂先天性心脏病患者接受动脉调转术。其中,大动脉转位合并室间隔完整(TGA-IVS)26例,大动脉转位合并室间隔缺损(TGA-VSD)19例,右心室双出口合并肺动脉下室间隔缺损(陶西格-宾氏病)16例。

结果

TGA-IVS组死亡2例,TGA-VSD组死亡4例,陶西格-宾氏病组死亡4例。手术总死亡率为16%。所有患者随访3个月至3年。所有患者紫绀消失,体力活动明显增加。1例陶西格-宾氏病患者二尖瓣中度反流无变化,2例TGA患者发生肺动脉瓣上和主动脉瓣上狭窄,压力阶差40 mmHg。1例肺动脉下狭窄合并残余室间隔缺损患者3个月后再次手术。所有存活者心功能良好。

结论

本研究中动脉调转术治疗TGA效果良好。用于治疗陶西格-宾氏病的手术方法可预防肺动脉梗阻,避免心室修补术引起的左心室流出道梗阻并发症。

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