Bisoi Akshay Kumar, Malankar Dhananjay, Chauhan Sandeep, Das Sambhunath, Ray Ruma, Das Prasenjit
Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Interact Cardiovasc Thorac Surg. 2010 Dec;11(6):768-72. doi: 10.1510/icvts.2010.247056. Epub 2010 Sep 23.
Over the years the age limit for the arterial switch operation (ASO) is being redefined with increasing expertise and adoption of extra-corporeal membrane oxygenator (ECMO) in the surgical program. We conducted a study to see the differences in ultrastructural features in eight children with transposition of the great arteries, four with prepared and the remaining four with regressed left ventricle (LV) during the ASO. Children with prepared LV had prominent Z bands with uniform and round mitochondria, few fat vacuoles and minimal collagen in the background, whereas children with regressed LV had Z band disruption with non-uniform elliptical mitochondria and myofibrillary disarray and an abundance of fat vacuoles and collagen in the background. Children with regressed LV and abundance of collagen had a prolonged postoperative course. Collagen deposition in the LV may point to the situation where the postoperative course following ASO may be prolonged due to the increased time required for the regressed LV to increase its mass and to sustain the systemic circulation.
多年来，随着专业技术的不断提高以及体外膜肺氧合（ECMO）在外科手术方案中的应用，动脉调转手术（ASO）的年龄限制正在重新界定。我们开展了一项研究，观察8例大动脉转位患儿在ASO期间左心室（LV）的超微结构特征差异，其中4例左心室已做好准备，其余4例左心室已退化。左心室已做好准备的患儿，其Z带明显，线粒体均匀且呈圆形，脂肪空泡较少，背景中胶原含量极少；而左心室已退化的患儿，Z带断裂，线粒体呈非均匀椭圆形，肌原纤维排列紊乱，背景中有大量脂肪空泡和胶原。左心室已退化且胶原含量丰富的患儿术后病程延长。左心室中的胶原沉积可能表明，由于退化的左心室增加其质量并维持体循环所需时间增加，ASO术后病程可能会延长。
