Crupi G, Anderson R H, Ho S Y, Lincoln C, Buckley M J
J Thorac Cardiovasc Surg. 1979 Nov;78(5):730-8.
Surgical management of patients with complete transposition and intact ventricular septum may become difficult in the presence of left ventricular outflow tract obstruction. A Mustard operation and direct resection of the obstruction through the pulmonary artery has been the treatment of choice for this combination. Our study of the structure of the left ventricular outflow tract in four specimens with the anatomic findings of complete transposition, intact ventricular septum, and subpulmonary stenosis suggests that direct resection of the stenosis through the pulmonary artery can seldom be adequate without major risk of damaging either the mitral valve or the conduction tissue. An alternative procedure, namely, a combined Mustard operation and insertion of an external conduit from the left ventricle to the main pulmonary artery, has been employed in the management of six patients with this combination of lesions. One early and one late death occurred. Postoperative cardiac catheterization performed in all of the survivors before discharge from the hospital showed good relief of the stenosis and no significant gradient across the conduit.
对于完全性大动脉转位且室间隔完整的患者，若存在左心室流出道梗阻，手术管理可能会变得困难。Mustard手术以及经肺动脉直接切除梗阻一直是针对这种情况的首选治疗方法。我们对四个具有完全性大动脉转位、室间隔完整及肺动脉瓣下狭窄解剖学表现的标本进行了左心室流出道结构研究，结果表明，经肺动脉直接切除狭窄很少能充分实现，且存在损伤二尖瓣或传导组织的重大风险。一种替代手术，即Mustard手术联合从左心室到主肺动脉置入外部管道，已用于治疗六例患有这种联合病变的患者。发生了1例早期死亡和1例晚期死亡。所有幸存者在出院前均进行了术后心导管检查，结果显示狭窄得到了良好缓解，且管道两端无明显压差。
