Department of Pediatric Cardiology, University Hospital, Lausanne, Switzerland.
Ann Thorac Surg. 2012 Oct;94(4):1311-6. doi: 10.1016/j.athoracsur.2012.04.095. Epub 2012 Aug 25.
In late-diagnosed transposition of the great arteries (TGA), the left ventricle (LV) involutes as it pumps against low resistance and needs retraining by applying a pulmonary artery band (PAB) in preparation for an arterial switch operation. We report our experience with a telemetrically adaptable band compared with classic banding.
Ten patients underwent retraining of the LV, 4 patients with an adaptable band and progressive weekly tightening of the band (group 1) and 6 patients with a traditional band (group 2).
Mean weight and age at pulmonary band placement was 5.8±2.36 kg and 11.7±11.1 months for group 1 and 5.0±2.3 kg and 6.4±7.6 months for group 2. Time between palliation and switch procedure was 4.2 months in both groups. Group 1 showed an initial mean pulmonary gradient of 25.5±4.43 mm Hg with a 5% closure of the device. The mean gradient increased with progressive closure to 63.5±9.8 mm Hg at the time of the arterial switch operation. There were no reinterventions or deaths in this group. In group 2, the mean pulmonary gradient increased with growth from 49±21.4 mm Hg to 68.4±7.86 mm Hg at the time of the switch procedure. However, 4 of these patients required reoperations during retraining: 2 needed 1 reoperation and 2 needed 2 reoperations. Two patients died-1 after banding and 1 after the switch operation.
Retraining of the LV by the adaptable device allows precise control of the tightening, avoids repetitive operations, and diminishes morbidity.
在晚期诊断的大动脉转位（TGA）中，左心室（LV）在对抗低阻力的情况下会退缩，需要通过应用肺动脉带（PAB）来进行重新训练，为动脉切换手术做准备。我们报告了一种可远程调节的带与传统带的比较经验。
10 名患者接受了 LV 的重新训练，其中 4 名患者使用了可调节带，并进行每周逐渐收紧带的操作（第 1 组），6 名患者使用了传统带（第 2 组）。
第 1 组的平均体重和肺动脉带放置时的年龄为 5.8±2.36kg 和 11.7±11.1 个月，第 2 组为 5.0±2.3kg 和 6.4±7.6 个月。两组的姑息治疗与切换手术之间的时间均为 4.2 个月。第 1 组最初的平均肺动脉梯度为 25.5±4.43mmHg，设备关闭 5%。随着逐渐关闭，平均梯度增加至动脉切换手术时的 63.5±9.8mmHg。该组无再次介入或死亡。在第 2 组中，随着生长，平均肺动脉梯度从 49±21.4mmHg 增加至切换手术时的 68.4±7.86mmHg。然而，这 4 名患者中有 2 名在重新训练时需要再次手术：1 名需要 1 次再次手术，2 名需要 2 次再次手术。2 名患者死亡-1 名在带后，1 名在切换手术后。
使用可调节装置对 LV 进行重新训练可实现精确的收紧控制，避免重复操作，并减少发病率。
