Yamagishi M, Imai Y, Kurosawa H, Sawatari K, Kawada M, Matsuo K
Nihon Kyobu Geka Gakkai Zasshi. 1989 Jun;37(6):1266-71.
A successful Jatene procedure (Lecompte modification) in a 8-month old boy with the intermediate type between the original Taussig-Bing and the posterior transposition of the great arteries (p-TGA) is described. The aorta was located posterior to the right of the pulmonary artery (PA) which overrode the interventricular septum. There was no fibrous continuity between aortic and atrioventricular valves. In the original Taussig-Bing, intraventricular rerouting is applicable because of malaligned infundibular septum. However, in our case which was similar to p-TGA, the infundibular septum extending anteriorly as far down as the anterior papillary muscle, was almost aligned to the interventricular septum, so that intraventricular rerouting is not applicable but arterial switch operation is preferable. Hence, the primary interventricular foramen was enlarged by the wedge resection and the secondary interventricular foramen was closed using pericardial patch through PA. The continuity of PA was reestablished anterior to the new aorta. The left half of distal orifice of PA was suture-closed to shift the site of anastomosis rightwards to avoid kinking and compression on the coronary arteries. Postoperative catheterization demonstrated no pressure gradient between left ventricle and aorta.
描述了在一名8个月大、患有介于原始陶西格-宾（Taussig-Bing）畸形和大动脉后位转位（p-TGA）之间中间类型的男孩身上成功实施的贾滕内手术（勒孔特改良术）。主动脉位于肺动脉（PA）右侧后方，肺动脉骑跨于室间隔之上。主动脉瓣与房室瓣之间无纤维连续性。在原始的陶西格-宾畸形中，由于漏斗间隔排列不齐，可行心室内改道。然而，在我们这个类似于p-TGA的病例中，漏斗间隔向前延伸至前乳头肌水平，几乎与室间隔对齐，因此心室内改道不可行，而动脉调转手术更为可取。因此，通过楔形切除术扩大了原发性室间孔，并通过肺动脉使用心包补片封闭了继发性室间孔。在新主动脉前方重建了肺动脉的连续性。肺动脉远端开口的左半部分缝合关闭，将吻合部位向右移位，以避免冠状动脉扭结和受压。术后心导管检查显示左心室与主动脉之间无压力阶差。
