Files Matthew D, Arya Bhawna
Seattle Children's Hospital, Seattle, WA, USA
Seattle Children's Hospital, Seattle, WA, USA.
Semin Cardiothorac Vasc Anesth. 2015 Sep;19(3):210-22. doi: 10.1177/1089253215581851. Epub 2015 Apr 21.
Transposition of the great arteries (TGA) refers to hearts with concordant atrioventricular connections but discordant ventriculoarterial connections. In this lesion, the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle. As such, the pulmonary and aortic circulations run in parallel as opposed to in series, and this lesion is not compatible with survival without adequate mixing of these circulations. The management and outcomes of TGA parallels the field of pediatric cardiac surgery itself. Uniformly fatal in childhood, palliative procedures from the 1950s to 1970s offered survival, albeit at a high early and late cost. In the 1970s, the arterial switch operation (ASO) provided an anatomical "cure," with survival to adulthood in the current era of around 90%. Detailed perioperative imaging, attention to associated lesions, and comprehension of the physiology are critical to medical and surgical management.
大动脉转位（TGA）是指房室连接一致但心室动脉连接不一致的心脏。在这种病变中，主动脉起源于右心室，肺动脉起源于左心室。因此，肺循环和主动脉循环是并行运行而非串联，并且如果这些循环没有充分混合，这种病变将无法存活。TGA的治疗和预后与小儿心脏外科领域本身密切相关。在儿童期这种病如不治疗会是致命的，20世纪50年代至70年代的姑息手术虽能让患儿存活，但早期和晚期的代价都很高。20世纪70年代，动脉调转手术（ASO）提供了一种解剖学上的“治愈”方法，在当今时代，成年后的存活率约为90%。详细的围手术期影像学检查、对相关病变的关注以及对生理学的理解对于药物和手术治疗至关重要。
