完全性大动脉转位合并室间隔缺损及重度肺动脉高压患儿行大动脉调转术的早中期结局对比分析。

Comparative analysis of early and middle outcomes of the arterial switch operation in children with complete transposition of the great arteries with ventricular septal defect and severe pulmonary artery hypertension.

机构信息

Department of Pediatric Cardiology, Beijing An Zhen Hospital Affiliated to Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.

出版信息

Chin Med J (Engl). 2013;126(11):2074-8.

PMID:23769560

Abstract

BACKGROUND

The best age for the arterial switch operation (ASO) in complete transposition of great arteries with ventricular septal defect is usually considered to be within six months. This is because of severe pulmonary arterial hypertension and pulmonary arterial obstructive pathological changes. There are few reports on ASO surgery in children older than three years old.

METHODS

We studied 41 children, including 24 males and 17 females, from January 2010 to December 2011. They were divided into three groups by operation age; 15 patients were < 1 year old, 13 were 1 - 3 years old, and 13 were > 3 years old. Associated cardiac abnormalities included patent ductus arteriosus in six cases, atrial septal defect in five cases, and mitral regurgitation in two cases. All the patients had echocardiography before the operation. Seventeen patients underwent a coronary computed tomography examination and five patients underwent right heart catheterization. All ASO surgeries were performed under inhalation anesthesia and hypothermic cardiopulmonary bypass.

RESULTS

Three operative deaths occurred. Two were in the < 1 year old group, who died from severe postoperative low cardiac output. The other was two years old and died of postoperative multiple organ failure. There was no significant difference in postoperative mortality and the recent mid-term survival rate among the three groups. Thirty-eight cases were followed up for an average of 11.2 months, ranging 6 - 20 months. One seven years old patient died of acute diarrhea and electrolyte disturbance arrhythmia caused by food poisoning. Three patients more than three years old still had residual pulmonary arterial hypertension.

CONCLUSION

Children older than three years old can still undergo the ASO procedure, but residual pulmonary hypertension is present.

摘要

背景

完全性大动脉转位合并室间隔缺损行大动脉调转术（ASO）的最佳年龄通常认为是在 6 个月以内。这是因为存在严重的肺动脉高压和肺动脉阻塞性病理改变。对于年龄大于 3 岁的患儿行 ASO 手术的报道较少。

方法

回顾性分析 2010 年 1 月至 2011 年 12 月我院收治的 41 例完全性大动脉转位合并室间隔缺损患儿的临床资料，根据手术年龄分为 3 组，年龄<1 岁 15 例，1~3 岁 13 例，>3 岁 13 例。合并动脉导管未闭 6 例，房间隔缺损 5 例，二尖瓣反流 2 例。所有患儿术前均行超声心动图检查，17 例行冠状动脉 CT 检查，5 例行右心导管检查。均在吸入麻醉和中度低温体外循环下行 ASO 手术。

结果

3 例死亡，其中<1 岁组 2 例，死于术后严重低心排血量；另 1 例 2 岁，死于术后多器官功能衰竭。3 组患儿术后死亡率及近期中期生存率差异无统计学意义。38 例获得随访，平均随访 11.2 个月，6~20 个月。1 例 7 岁患儿因急性腹泻、食物中毒致电解质紊乱引发心律失常死亡。3 例>3 岁患儿仍存在残余肺动脉高压。