Coto E O, Norwood W I, Lang P, Castaneda A R
J Thorac Cardiovasc Surg. 1979 Nov;78(5):721-9.
Since February, 1978, 42 infants ranging in age from 15 days to 16 months (mean age 6 months) and weighing between 2.0 and 9.0 kg (mean weight 5.8 kg) underwent a modified Senning I operation. Eleven (26%) underwent operation during the first 3 months of life. Twenty-nine patients had dextro-transposition of the great arteries (d-TGA) and an intact ventricular septum (Group I), and 13 patients had d-TGA and a large ventricular septal defect (VSD) (Group 2). In addition to the Senning I procedure, 13 patients had transatrial closure of their VSD, eight had ligation of a patient ductus arterioses, two had removal of a pulmonary artery band, and four had trans-pulmonary artery resection of short-segment subpulmonary stenosis. Modification of the original Senning operation included (1) patch augmentation (pericardium or Gore-Tex) of the atrial septal flap and (2) pericardial patch enlargement of the pulmonary venous pathway. One patient in Group 1 (3%) and two patients in Group 2 (15%) died after operation. A 2-week-old infant (Group 1) was treated with prostaglandin E1 (PGE) for 2 weeks before operation. The other hospital deaths (Group 2) occurred in a 2-month-old infant with advanced ischemic damage to the right ventricle and a 4-month-old child with multiple VSDs and Grade IV pulmonary vascular disease. No caval gradients were found after modification of the right atrial incision. Two patients died later from pulmonary venous obstruction, one during attempted recatheterization and the other after repair of the pulmonary venous obstruction. One patient had transient complete heart block, and four were discharged in junctional rhythm. Thirty-four patients (87%) were in regular sinus rhythm when released from the hospital. Postoperative catheterizations in eight patients showed no significant gradients in six and severe pulmonary venous obstruction in two (late deaths). More late postoperative results are required, including postoperative catheterization and electrophysiological studies, before the relative merits of the Senning versus the Mustard operation can be assessed.
自1978年2月以来，42例年龄在15天至16个月（平均年龄6个月）、体重在2.0至9.0千克（平均体重5.8千克）之间的婴儿接受了改良的森宁I型手术。11例（26%）在出生后的前3个月接受了手术。29例患者患有大动脉右位转位（d-TGA）且室间隔完整（I组），13例患者患有d-TGA且有大型室间隔缺损（VSD）（2组）。除了森宁I型手术外，13例患者经房间隔关闭了VSD，8例结扎了动脉导管未闭，2例移除了肺动脉束带，4例经肺动脉切除了短节段肺动脉瓣下狭窄。对原始森宁手术的改良包括：（1）用补片（心包或戈尔特斯材料）扩大房间隔瓣；（2）用心包补片扩大肺静脉通路。I组1例患者（3%）和2组2例患者（15%）术后死亡。1例2周大的婴儿（I组）在手术前接受了2周的前列腺素E1（PGE）治疗。其他医院死亡病例（2组）发生在1例右心室有晚期缺血性损伤的2个月大婴儿和1例有多个VSD及IV级肺血管疾病的4个月大儿童身上。改良右心房切口后未发现腔静脉压差。2例患者后来死于肺静脉梗阻，1例在尝试再次导管插入术时死亡，另1例在肺静脉梗阻修复后死亡。1例患者出现短暂性完全性心脏传导阻滞，4例以交界性心律出院。34例患者（87%）出院时为窦性心律。8例患者术后导管检查显示，6例无明显压差，2例有严重肺静脉梗阻（晚期死亡病例）。在能够评估森宁手术与马斯塔德手术的相对优缺点之前，还需要更多的术后远期结果，包括术后导管检查和电生理研究。
