Fang Min-hua, Zhu Hong-yu, Wang Zeng-wei, Song Heng-chang, Zhang Nan-bin, Zhe Ji
Department of Cardiovascular Surgery, the General Hospital of Shenyang Military Region, Shenyang 110015, China.
Zhonghua Wai Ke Za Zhi. 2008 Apr 15;46(8):570-3.
To determine the outcome of anatomically corrective repair and traditional repair of corrected transposition of great arteries (c-TGA) with heart anomaly.
From April 2002 to December 2006, nineteen patients including fourteen male and five female with c-TGA, underwent operations, age ranged from 2 to 22 years old and weight ranged from 10 to 48 kg. Fifteen of them received anatomically corrective repair and the other four received traditional repair. Eighteen patients were referred to SLL (segmental anatomy) in situs solitus while fifteen of them with levocardia and three with dextrocardia. One patient was referred to IDD (segmental anatomy) in situs inversus with levocardia. Associated cardiac lesions included ventricular defect in eighteen patients, double outlet of right ventricle in one patient, pulmonary stenosis in seventeen patients and pulmonary hypertension in two patients. The operative procedures to anatomically correct atrioventricular discordance included an atrial switch plus a ventricle-arterial switch. The atrial switch was performed using the modified Senning procedure (n=13), Senning procedure (n=1) and Mustard procedure (n=1). The ventricle-arterial switch was performed using a Rastelli procedure (n=13) or an arterial switch (n=2). The patients underwent Mustard and Rastelli procedure had received bi-direct Gleen shunt due to postoperative high pressure of superior vena cava. Three patients underwent traditional cardiac repair because of small ventricular septal defect and one patient was reoperated to undergo traditional cardiac repair because of left ventricular failure after received anatomically corrective repair.
In the patients received anatomically corrective repair, there was one early operative death received a modified Senning atrial switch and an arterial switch. The cause of death was acute myocardial failure due to imperfect coronary transfer. The postoperative complications included severe low cardiac output syndrome (n=1), temporary atrioventricular block (n=1) and thorax cavity fluidify (n=1). The survivors were followed up for 6 months to 4 years. All were sinus cardiac rhythm and in NYHA class I or II. There was no death in the patients received traditional repair. Four patients were followed up for 1 year. Three patients were in NYHA I or II class and one patient in class II.
Anatomically corrective repair of c-TGA can be performed with good operative survival and intermediate-term outcome. The patients with good right ventricular function and well developed tricuspid valve who were difficult to undergo anatomically corrective repair might be fit to receive traditional repair.
确定大动脉转位矫正型（c-TGA）合并心脏畸形的解剖矫正修复和传统修复的结果。
2002年4月至2006年12月，19例c-TGA患者接受手术，其中男性14例，女性5例，年龄2至22岁，体重10至48千克。15例接受解剖矫正修复，另外4例接受传统修复。18例患者为心房正位的节段性解剖（SLL），其中15例心脏左位，3例心脏右位。1例患者为心脏左位的镜面右位心节段性解剖（IDD）。相关心脏病变包括18例室间隔缺损、1例右心室双出口、17例肺动脉狭窄和2例肺动脉高压。解剖矫正房室不一致的手术步骤包括心房调转术加心室-动脉调转术。心房调转术采用改良森宁手术（n = 13）、森宁手术（n = 1）和马斯塔德手术（n = 1）。心室-动脉调转术采用Rastelli手术（n = 13）或动脉调转术（n = 2）。接受马斯塔德和Rastelli手术的患者因术后上腔静脉高压接受了双向格林分流术。3例患者因室间隔缺损小接受传统心脏修复，1例患者在接受解剖矫正修复后因左心室衰竭再次手术接受传统心脏修复。
在接受解剖矫正修复的患者中，1例早期手术死亡，该患者接受了改良森宁心房调转术和动脉调转术。死亡原因是冠状动脉转移不完善导致的急性心肌衰竭。术后并发症包括严重低心排血量综合征（n = 1）、暂时性房室传导阻滞（n = 1）和胸腔积液（n = 1）。存活者随访6个月至4年。所有患者均为窦性心律，纽约心脏协会（NYHA）心功能分级为I级或II级。接受传统修复的患者无死亡。4例患者随访1年。3例患者NYHA心功能分级为I级或II级，1例为II级。
c-TGA的解剖矫正修复手术生存率良好，中期结果较好。右心室功能良好且三尖瓣发育良好但难以进行解剖矫正修复的患者可能适合接受传统修复。
