Rastan H
J Thorac Cardiovasc Surg. 1975 Mar;69(3):407-14.
Our initial method of closed atrial septectomy, used in the palliative therapy of transposition of the great arteries (TGA), failed to produce a technical success in 1 of 5 patients. Subsequently, we modified the technique by securing the septum on traction sutures and simplifying the introduction of the septectome. With the new method, we achieved technical success in all 13 patients so treated. In our total of 18 patients treated by closed atrial septectomy, 7 had TGA with no other cardiac anomaly, and none of the 7 died. Of the remaining 11 patients who had TGA and other cardiac anomalies and required procedures such as ductus ligation, pulmonary artery banding, and aorta-right pulmonary artery shunt in addition to septectomy, 5 died. In only 1 of them, death was caused by technical complications with our initial method. Of the remaining four deaths, two were due to pre-existing cerebral damage and two to complications of palliative procedures done in conjunction with atrial septectomy. Side-to-side anastomosis between the superior vena cava and right pulmonary artery, carried out successfully in 1 case, is suggested as an additional palliative measure to supplement atrial septectomy in TGA.
我们最初用于大动脉转位（TGA）姑息治疗的闭合性房间隔切除术方法，在5例患者中有1例未取得技术成功。随后，我们通过在牵引缝线上固定隔膜并简化隔膜刀的引入来改进该技术。采用新方法后，接受治疗的13例患者均取得了技术成功。在我们总共18例接受闭合性房间隔切除术治疗的患者中，7例患有TGA且无其他心脏异常，这7例患者均未死亡。其余11例患有TGA和其他心脏异常且除房间隔切除术外还需要进行诸如动脉导管结扎、肺动脉环扎和主动脉 - 右肺动脉分流等手术的患者中，5例死亡。其中只有1例死亡是由我们最初方法的技术并发症导致的。在其余4例死亡病例中，2例是由于先前存在的脑损伤，2例是由于与房间隔切除术同时进行的姑息性手术的并发症。1例患者成功进行了上腔静脉与右肺动脉之间的侧侧吻合术，建议将其作为一种额外的姑息性措施，以补充TGA患者的房间隔切除术。
