Sachdeva Shagun, Jacobsen Roni M, Woods Ronald K, Mitchell Michael E, Cava Joseph R, Ghanayem Nancy S, Frommelt Peter C, Bartz Peter J, Tweddell James S
Children's Hospital of Wisconsin, Milwaukee, WI, USA.
Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
Pediatr Cardiol. 2017 Dec;38(8):1696-1702. doi: 10.1007/s00246-017-1715-5. Epub 2017 Sep 16.
We present our experience for patients who have undergone an anatomic repair (AR) for congenitally corrected transposition of the great arteries (CCTGA) at the Children's Hospital of Wisconsin. A retrospective chart review of patients who underwent AR for CCTGA from 2001 to 2015 was performed. The cohort consisted of 15 patients (74% male). Median age of anatomic repair was 15 months (range 4.5-45.6 months). Four patients had a bidirectional Glenn (BDG) prior to AR. At the time of AR,-9 (60%) underwent Senning/Rastelli procedure, 4 (26.6%) had double switch operation, and 2 (13.3%) underwent only Senning with VSD closure. Median duration of follow-up was 5.5 years (0.05-14 years). Reoperations prior to discharge included BDG, revision of pulmonary venous baffle, closure of residual VSD, and pacemaker placement. Late reoperations included left ventricular outflow tract obstruction repair, conduit replacement, melody valve placement, and pacemaker implantation. At their most recent follow-up, no patient had heart failure symptoms and only 1 had severely diminished function that improved with cardiac resynchronization therapy. Moderate mitral regurgitation was noted in 15% (2/13), and severe in 7% (1/13). Moderate tricuspid regurgitation was noted in 15% (2/13). One patient, 7% (1/13), developed moderate aortic insufficiency. There was a 100% survival at the time of the most recent follow-up. Patients with CCTGA who have undergone AR have excellent functional status and mid-term survival but reinterventions are common. Longer term studies are needed to determine both the extent and spectrum of reinterventions as well as long term survival.
我们介绍了在威斯康星儿童医院对接受大动脉转位（CCTGA）解剖修复术（AR）的患者的治疗经验。对2001年至2015年接受CCTGA的AR治疗的患者进行了回顾性病历审查。该队列包括15名患者（74%为男性）。解剖修复的中位年龄为15个月（范围4.5 - 45.6个月）。4名患者在AR之前接受了双向格林分流术（BDG）。在进行AR时，9例（60%）接受了森宁/拉斯泰利手术，4例（26.6%）进行了双调转手术，2例（13.3%）仅接受了森宁手术并关闭室间隔缺损。中位随访时间为5.5年（0.05 - 14年）。出院前的再次手术包括BDG、肺静脉挡板修复、残余室间隔缺损关闭和起搏器植入。后期再次手术包括左心室流出道梗阻修复、管道置换、美敦力瓣膜置入和起搏器植入。在最近一次随访时，没有患者出现心力衰竭症状，只有1例功能严重受损，经心脏再同步治疗后有所改善。15%（2/13）的患者出现中度二尖瓣反流，7%（1/13）的患者出现重度二尖瓣反流。15%（2/13）的患者出现中度三尖瓣反流。1例患者（7%，1/13）出现中度主动脉瓣关闭不全。在最近一次随访时生存率为100%。接受AR治疗的CCTGA患者功能状态良好，中期生存率较高，但再次干预很常见。需要进行长期研究以确定再次干预的范围和频谱以及长期生存率。
