Wakaki N, Shirotani H, Oku H, Yokoyama T, Miyake T, Tateishi K
Nihon Kyobu Geka Gakkai Zasshi. 1989 Oct;37(10):2233-40.
A five months old infant with the transposition of the great arteries with posterior aorta undergoing arterial switch operation is reported. A pre-operative diagnosis of the transposition of the great arteries with posterior aorta, subarterial ventricular septal defect, anterior pulmonary artery, bilateral conus and fibrous continuity between aortic and mitral valve was made. This diagnosis was confirmed by the open heart surgery. The ventricular septal defect was subaortic from the transected aortic aspect, and the infundibular and trabecular septum was aligned. For these reasons, this subarterial ventricular septal defect was easily closed transaortically. The right coronary artery arose from the left sinus and the left coronary artery from the posterior sinus, so the coronary arterial pattern of this patient was a Shaher type 9. And in addition, another small ostium located in the left sinus gave rise to an additional small branch. Translocation of the coronary arteries was performed. The new pulmonary trunk was reconstructed to the right pulmonary artery so as not to compress the coronary artery and distort the great arteries. This patient was restudied three months after the repair. The right to left ventricular systolic pressure ratio was 0.42 and no pressure gradient was present between the right ventricle and the right pulmonary artery. But a moderate aortic regurgitation was detected. This was caused by deformity of the aortic sinus of valsalva. Only 28 patients with the transposition of the great arteries with posterior aorta were reported in the literature, but there were no reports on the successful surgical treatment for its rare anomaly, to our knowledge.(ABSTRACT TRUNCATED AT 250 WORDS)
本文报道了一名5个月大患有大动脉转位伴后位主动脉的婴儿接受动脉调转手术的情况。术前诊断为大动脉转位伴后位主动脉、动脉下室间隔缺损、肺动脉在前、双侧圆锥以及主动脉与二尖瓣之间存在纤维连接。这一诊断经心脏直视手术得以证实。从横断的主动脉层面看,室间隔缺损位于主动脉下,漏斗部和小梁部间隔对齐。基于这些原因,经主动脉途径可轻松闭合该动脉下室间隔缺损。右冠状动脉起源于左窦,左冠状动脉起源于后窦,因此该患者的冠状动脉形态为沙赫尔9型。此外,位于左窦的另一个小开口发出一条额外的小分支。进行了冠状动脉移位术。新的肺动脉干重建至右肺动脉,以免压迫冠状动脉并使大动脉扭曲。该患者在修复术后3个月接受复查。右心室与左心室收缩压比值为0.42,右心室与右肺动脉之间无压力阶差。但检测到中度主动脉瓣反流。这是由主动脉瓣窦畸形所致。据我们所知,文献中仅报道了28例大动脉转位伴后位主动脉的患者,但对于这种罕见畸形尚无成功手术治疗的报道。(摘要截取自250词)