Baslaim Ghassan M
Division of Cardiothoracic Surgery, Department of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
J Card Surg. 2006 Sep-Oct;21(5):465-70. doi: 10.1111/j.1540-8191.2006.00278.x.
To determine the effect of preoperative echocardiographic delineation of coronary artery pattern on the immediate postoperative result of arterial switch procedures.
A retrospective review of a consecutive series of children who underwent the arterial switch operation at a single institution from February 2001 to December 2004.
Sixty-six children underwent an arterial switch operation. The median age at the time of repair was 1.17 months (range 0.2-96 months). Fifty-five patients (83%) were diagnosed to have dextro-transposition of the great arteries, and 11 patients (17%) had double outlet right ventricle of the Taussig-Bing type. Associated left-sided obstructive lesions were present in 12 cases (18.3%). The dominant coronary pattern was 1 LCX; 2R (60.6%), and followed by 1L; 2RCX (24.2%). The techniques used for coronary transfer were the trapdoor flap, circular buttonhole transfer, or combined technique in all patients except for one case. Preoperatively, the coronary artery anatomy was adequately delineated in only 26 cases (39.4%). Forty patients (60.6%) had either different coronary description or non-documented coronary artery pattern. Myocardial ischemia was not observed in any case postoperatively and no patient in the series required reoperation for coronary revision. There were 10 in-hospital deaths (15%) not related to the coronary pattern. Follow-up is available for 49 of the surviving patients (87.5%) at a mean of 10.1 months. There has been no readmission or reintervention for myocardial ischemia.
The trapdoor flap and circular buttonhole techniques are the most practical and reproducible maneuvers of coronary transfer during arterial switch operation. Both techniques can compensate for inadequate preoperative echocardiographic delineation of coronary artery pattern.
确定术前超声心动图描绘冠状动脉形态对动脉调转术术后即刻结果的影响。
回顾性分析2001年2月至2004年12月在单一机构接受动脉调转手术的一系列连续儿童病例。
66例儿童接受了动脉调转手术。修复时的中位年龄为1.17个月(范围0.2 - 96个月)。55例患者(83%)被诊断为大动脉右位转位,11例患者(17%)患有陶西格 - 宾型右心室双出口。12例(18.3%)存在相关的左侧梗阻性病变。主要的冠状动脉形态为1支左旋支;2支右冠状动脉(60.6%),其次是1支左冠状动脉;2支右冠状动脉和左旋支(24.2%)。除1例患者外,所有患者冠状动脉转移采用的技术为活板门瓣、圆形扣眼转移或联合技术。术前,仅26例(39.4%)患者的冠状动脉解剖结构得到充分描绘。40例(60.6%)患者的冠状动脉描述不同或冠状动脉形态未记录。术后未观察到任何心肌缺血病例,该系列中无患者因冠状动脉修正需要再次手术。有10例(15%)住院死亡与冠状动脉形态无关。49例存活患者(87.5%)获得随访,平均随访时间为10.1个月。没有因心肌缺血再次入院或再次干预的情况。
活板门瓣和圆形扣眼技术是动脉调转术中冠状动脉转移最实用且可重复的操作。这两种技术都可以弥补术前超声心动图对冠状动脉形态描绘不足的情况。