Erek Ersin, Suzan Dilek, Aydın Selim, Yıldız Okan, Kırat Barış, Demir I Halil, Ödemiş Ender
Department of Pediatric Cardiac Surgery, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey.
Department of Pediatric Cardiac Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Turk Gogus Kalp Damar Cerrahisi Derg. 2019 Jun 19;27(3):266-273. doi: 10.5606/tgkdc.dergisi.2019.17245. eCollection 2019 Jul.
This study aims to present the outcomes of arterial switch operation for Taussig-Bing anomaly versus transposition of the great arteries and ventricular septal defect.
Between November 2010 and December 2016, a total of 100 consecutive arterial switch operations in 42 pediatric patients (25 males, 17 females; median age 17 days; range, 2 to 210 days) were performed in two centers. Among them, 42 patients had associated ventricular septal defect and were diagnosed with Taussig-Bing anomaly (n=15) or transposition of the great arteries and ventricular septal defect (n=27). Aortic arch anomalies were present in six patients (40%) with Taussig-Bing anomaly and two patients (7.4%) with transposition of the great arteries and ventricular septal defect (p=0.016). Coronary anomaly was observed in five (33.3%) and six (22.2%) patients, respectively. All patient had a large defect (multiple n=4), except for eight patients who had moderate defect in the transposition of the great arteries group.
Early mortality was 13.3% in the Taussig-Bing anomaly group and 7.4% in the other group. Extracorporeal membrane oxygenation support was needed in three patients. Delayed sternal closure was used in most of the patients (92.9%). The median length of intensive care unit and hospital stays were similar between the groups. The median follow-up was 16 (range, 1 to 50) months. Two patients including one planned (debanding and multiple defect closure) and one unplanned (residual defect closure) were reoperated. Three patients needed aortic balloon angioplasty due to recoarctation and one patient underwent pulmonary balloon angioplasty. Overall reintervention rate was 18.4%.
Although the incidence of aortic arch and coronary anomalies were higher in patients with Taussig-Bing anomaly, early and mid-term results were similar. Based on these results, primary arterial switch operation seems to be successfully performed for both pathologies.
本研究旨在呈现法洛四联症与大动脉转位合并室间隔缺损行动脉调转术的结果。
2010年11月至2016年12月期间，两个中心共对42例儿科患者（男25例，女17例；中位年龄17天；范围2至210天）连续进行了100例动脉调转术。其中，42例患者合并室间隔缺损，被诊断为法洛四联症（n = 15）或大动脉转位合并室间隔缺损（n = 27）。法洛四联症患者中有6例（40%）存在主动脉弓异常，大动脉转位合并室间隔缺损患者中有2例（7.4%）存在主动脉弓异常（p = 0.016）。分别在5例（33.3%）和6例（22.2%）患者中观察到冠状动脉异常。除大动脉转位组中有8例患者存在中度缺损外，所有患者均有较大缺损（4例为多发）。
法洛四联症组早期死亡率为13.3%，另一组为7.4%。3例患者需要体外膜肺氧合支持。大多数患者（92.9%）采用了延迟胸骨闭合。两组间重症监护病房住院时间和住院总时间的中位数相似。中位随访时间为16（范围1至50）个月。2例患者再次手术，其中1例为计划内手术（解除缩窄和闭合多发缺损），1例为非计划内手术（闭合残余缺损）。3例患者因再狭窄需要进行主动脉球囊血管成形术，1例患者进行了肺动脉球囊血管成形术。总体再次干预率为18.4%。
尽管法洛四联症患者主动脉弓和冠状动脉异常的发生率较高，但早期和中期结果相似。基于这些结果，对于这两种病变，一期动脉调转术似乎均可成功实施。
