Tocharoenchok Teerapong, Sriyoschati Somchai, Tongcharoen Punnarerk, Tantiwongkosri Kriangkrai, Subtaweesin Thaworn
Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Asian Cardiovasc Thorac Ann. 2016 Jun;24(5):428-34. doi: 10.1177/0218492316645749. Epub 2016 Apr 19.
Anatomic repair has become the preferred option in the subgroup of patients with congenitally corrected transposition of the great arteries with ventricular septal defect and pulmonary obstruction. We report our 14-year experience with this approach.
From April 2001 to February 2014, 22 patients with congenitally corrected transposition with ventricular septal defect and pulmonary obstruction underwent anatomic repair. Nineteen patients had a modified Senning-Rastelli procedure, 2 had a Mustard-Rastelli procedure, and one had a hemi-Mustard-Glenn-Rastelli procedure. The mean age was 10.9 years, and 8 (36.4%) patients were male.
There were 2 early deaths from sepsis and ventricular failure at 18 and 81 days postoperatively, and 3 late deaths from ventricular failure at 4, 33, and 113 months postoperatively. Left ventricular failure with mitral valve regurgitation was present in 3 of the 5 patients who died. Among the survivors, 3 underwent 4 transcatheter interventions for right ventricular outflow tract obstruction and 3 underwent 4 reoperations for atrial pathway obstruction, left and right ventricular outflow tract obstruction, or residual shunt. At a median follow-up of 64 months (range 14-167 months), 15 of 17 survivors were in functional class I. One patient had severe mitral valve regurgitation and was awaiting valve replacement. Another patient had right ventricular outflow conduit obstruction and was scheduled for reoperation.
Results of atrial switch-Rastelli procedures in this subgroup of patients with corrected transposition are satisfactory but still imperfect. Mitral regurgitation might predict a poor outcome. Long-term follow-up is necessary.
对于合并室间隔缺损和肺动脉梗阻的先天性矫正型大动脉转位患者亚组，解剖修复已成为首选治疗方法。我们报告了采用这种方法的14年经验。
2001年4月至2014年2月，22例合并室间隔缺损和肺动脉梗阻的先天性矫正型大动脉转位患者接受了解剖修复。19例患者接受改良森宁-拉斯特利手术，2例接受马斯塔德-拉斯特利手术，1例接受半马斯塔德-格林-拉斯特利手术。平均年龄为10.9岁，8例（36.4%）患者为男性。
术后18天和81天分别有2例因败血症和心室衰竭早期死亡，术后4个月、33个月和113个月有3例因心室衰竭晚期死亡。死亡的5例患者中有3例存在左心室衰竭合并二尖瓣反流。在幸存者中，3例因右心室流出道梗阻接受了4次经导管介入治疗，3例因心房通路梗阻、左和右心室流出道梗阻或残余分流接受了4次再次手术。中位随访64个月（范围14 - 167个月），17例幸存者中有15例心功能为I级。1例患者有严重二尖瓣反流，正在等待瓣膜置换。另1例患者有右心室流出道管道梗阻，计划再次手术。
在这一矫正型大动脉转位患者亚组中，心房调转-拉斯特利手术的结果令人满意，但仍不完善。二尖瓣反流可能预示预后不良。需要进行长期随访。
