German Pediatric Heart Centre, Asklepios Clinic Sankt Augustin, Arnold Janssen Str. 29, 53757 Sankt Augustin, Germany.
Eur J Cardiothorac Surg. 2011 Nov;40(5):1227-34. doi: 10.1016/j.ejcts.2011.01.077. Epub 2011 Mar 12.
Anatomic correction of corrected transposition of the great arteries, utilizing the morphologic left ventricle as a systemic pumping chamber, is considered the preferred method. The purpose of the study was to analyze the intermediate functional outcome following anatomical correction.
Between 1997 and 6/2010, 23 patients with corrected transposition of the great arteries and associated lesions underwent anatomical correction. Seventeen (74%) and six patients (26%) had situs solitus {S,L,L} and situs invs {I,D,D}, respectively. Fifteen patients (65%) had undergone 18 palliations before the corrective operation. The median age at palliation was 0.23 years, with a range of 0.016-8.4 years. A corrective, modified Senning-arterial switch procedure was performed in nine patients, 13 patients underwent a modified Senning-Rastelli procedure, and in one patient a combination of modified Senning and aortic translocation (Bex/Nikaidoh) was used. The median age at the corrective operation was 2 years (from 0.3 to 15.7 years).
There was no mortality or heart transplant within the mean follow-up of 3.4 years. Freedom from reintervention was 77% at 5 years. There were no signs of obstruction of the systemic and pulmonary venous tunnels. The function of both ventricles was normal in all patients, even in the four patients who required retraining of the left ventricle. Mild aortic regurgitation was noticed in three patients. Preoperatively detected significant tricuspid regurgitation either disappeared or became trivial after the operation in all the six patients. All patients except two are in sinus rhythm; one patient is pacemaker-dependent preoperatively and one is pacemaker-dependent postoperatively. There were no clinically apparent neurological problems. All patients, but one, are in the New York Heart Association (NYHA) class I.
Anatomic correction of corrected transposition of the great arteries can be performed in selected patients without mortality and with acceptable morbidity. The mid-term functional outcome is excellent, resulting in normal ventricular function, even in retrained left ventricles, and minimal incidence of complete heart block. The long-term function of the aortic valve, intraventricular tunnels, conduits, and ventricles requires close surveillance.
利用形态左心室作为体循环泵，对矫正型大动脉转位进行解剖矫正，被认为是首选方法。本研究的目的是分析解剖矫正后的中期功能结果。
1997 年至 2010 年 6 月，23 例矫正型大动脉转位合并相关病变患者接受解剖矫正。17 例（74%）和 6 例（26%）患者分别具有 situs solitus{ S,L,L}和 situs invs{ I,D,D}。15 例（65%）患者在矫正手术前接受了 18 次姑息性治疗。姑息性治疗的中位年龄为 0.23 岁，范围为 0.016-8.4 岁。9 例患者接受了改良的 Senning-动脉转换术，13 例患者接受了改良的 Senning-Rastelli 手术，1 例患者接受了改良的 Senning 和主动脉移位（Bex/Nikaidoh）的联合手术。矫正手术的中位年龄为 2 岁（0.3-15.7 岁）。
在平均 3.4 年的随访中，无死亡或心脏移植。5 年无再干预生存率为 77%。系统和肺静脉隧道无阻塞迹象。所有患者的左右心室功能均正常，即使是在需要重新训练左心室的 4 例患者中也是如此。3 例患者出现轻度主动脉瓣反流。所有 6 例术前发现明显三尖瓣反流的患者术后反流均消失或减轻为轻微。除 2 例患者外，所有患者均为窦性心律；1 例患者术前依赖起搏器，1 例患者术后依赖起搏器。无临床明显的神经问题。除 1 例患者外，所有患者均为纽约心脏协会（NYHA）I 级。
在选定的患者中，可安全地进行矫正型大动脉转位的解剖矫正，无死亡率，发病率可接受。中期功能结果良好，心室功能正常，即使是在重新训练的左心室中也是如此，完全性心脏阻滞的发生率也很低。主动脉瓣、室内隧道、导管和心室的长期功能需要密切监测。
