Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
Eur J Cardiothorac Surg. 2012 Oct;42(4):680-4. doi: 10.1093/ejcts/ezs055. Epub 2012 Mar 7.
The Senning or Mustard procedure combined with the arterial switch operation (ASO) (± VSD and no left ventricular (LV) outflow tract obstruction) or the Rastelli operation (VSD and LV outflow tract obstruction) has become the preferred strategy over conventional repair as it is thought to prevent long-term dysfunction of the right ventricle (RV). More recently, hemi-Mustard rerouting of blood from the inferior vena cava to the RV in combination with bidirectional cavopulmonary anastomosis (BCPA) has been adopted by some centres for potential benefits over the classic atrial switch procedure. The aim of this study was to analyse our experience with hemi-Mustard and BCPA as part of an anatomical repair of congenitally corrected transposition of the great arteries (CCTGA) in selected patients.
Between 2004 and 2011, eight patients underwent hemi-Mustard/BCPA with the Rastelli operation (n = 6) or ASO (n = 2). The median age was 2.9 (range: 1.2-9.1) years. Positional anomalies were present in 75% of the patients. Both patients with ASO had dysplastic and insufficient tricuspid valves. In the Rastelli group, four patients had previously received shunts followed by BCPA in one patient. In the ASO group, both patients underwent pulmonary artery banding initially.
There was one in-hospital death and no late mortality. Two patients received a pacemaker. One patient from the Rastelli group required conduit change 6 years later. At the mean follow-up of 4.5 years, six and one patients are in NYHA classes I and II, respectively; six patients showed good biventricular function, while one had LV dysfunction. Systemic venous obstruction and sinus node dysfunction were not observed, and BCPA was functioning well in all patients.
Hemi-Mustard/BCPA is useful in anatomical repair of CCTGA in selected patients. When compared with the classic atrial switch operation, it is technically easier which makes it especially helpful in atrio-apical discordance; it unloads an RV with limited size or function, and avoids complications related to the upper limb of the classic atrial switch procedure. Mid-term results of this approach are favourable. Further follow-up is needed to prove long-term benefits.
Senning 或 Mustard 手术联合动脉调转手术（ASO）（+/- 室间隔缺损和无左心室流出道梗阻）或 Rastelli 手术（室间隔缺损和左心室流出道梗阻）已成为首选策略，因为它被认为可以预防右心室（RV）的长期功能障碍。最近，一些中心采用了从下腔静脉向 RV 进行半 Mustard 分流术，结合双向腔肺吻合术（BCPA），以获得优于经典心房调转术的潜在益处。本研究的目的是分析我们在选定患者中使用半 Mustard/BCPA 进行先天性矫正性大动脉转位（CCTGA）解剖修复的经验。
2004 年至 2011 年，8 例患者接受了半 Mustard/BCPA 联合 Rastelli 手术（n=6）或 ASO（n=2）。中位年龄为 2.9 岁（范围：1.2-9.1 岁）。75%的患者存在位置异常。ASO 组的 2 例患者均存在发育不良和功能不全的三尖瓣。在 Rastelli 组中，4 例患者曾接受分流术，随后 1 例患者接受了 BCPA。ASO 组的 2 例患者最初均接受了肺动脉带缩术。
1 例患者住院期间死亡，无晚期死亡。2 例患者植入了起搏器。Rastelli 组的 1 例患者 6 年后需要更换导管。中位随访 4.5 年后，6 例和 1 例患者分别处于 NYHA 心功能分级 I 级和 II 级；6 例患者双心室功能良好，1 例患者左心室功能障碍。未观察到体静脉阻塞和窦房结功能障碍，所有患者的 BCPA 功能良好。
半 Mustard/BCPA 在选定的 CCTGA 患者的解剖修复中是有用的。与经典的心房调转手术相比，该技术更简单，尤其有助于心尖型房室不一致的患者；它可以减轻 RV 的负荷，即使 RV 体积较小或功能有限，并且可以避免经典心房调转手术上肢相关的并发症。该方法的中期结果是有利的。需要进一步随访以证明长期益处。
