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[大动脉完全转位(d-TGA)的完全矫正术及三尖瓣闭锁(TA)的Fontan手术]

[Total correction of complete transposition of the great arteries (d-TGA) and Fontan procedure for tricuspid atresia(TA)].

作者信息

Imai Y

出版信息

Nihon Geka Gakkai Zasshi. 1983 Sep;84(9):804-7.

PMID:6676650
Abstract

Since 1975, 87 patients underwent total correction consisting of 35 cases of Mustard procedure with 6 early deaths (17.1%), 36 Senning with 2 deaths (5.6%), 12 Rastelli operations with 4 deaths (33.3%), and Jatene procedure on 4 cases without mortality. Sixteen patients out of 63 early survivors following intraatrial repair resulted in fatal outcome. In 17 with a modified senning procedure with a pedicled autologous pericardial patch on the functional left atrium, 8 died of pulmonary venous obstruction caused by thickening and calcification of pericardium. However, no death was seen in 17 patients with original Senning procedure. Right ventricular function remained poor in cases with intra-arterial repair and accounted for relatively poor long-term results. Although Rastelli operation carried high early mortality, late death was seen only in 1. Jatene procedure was performed in 4 ranging in ages from 5 months to 6 years without mortality. Fontan procedure was done on 22 patients with 2 early deaths and no late death in tricuspid atresia. Average cardiac index after surgery was 2.6 +/- 0.6. Cardiac index showed close correlation with preoperative cross sectional area of both pulmonary artery divided by body surface area (PA-index), but had poor correlation with right atrial pressure or left ventricular volume.

摘要

自1975年以来,87例患者接受了完全矫正手术,其中35例行Mustard手术,6例早期死亡(17.1%);36例行Senning手术,2例死亡(5.6%);12例行Rastelli手术,4例死亡(33.3%);4例行Jatene手术,无死亡病例。心房内修复术后63例早期存活患者中有16例最终死亡。17例行改良Senning手术,在功能性左心房使用带蒂自体心包补片,其中8例死于心包增厚和钙化导致的肺静脉梗阻。然而,17例行原Senning手术的患者无死亡病例。动脉内修复的病例右心室功能持续较差,长期效果相对不佳。尽管Rastelli手术早期死亡率较高,但晚期仅1例死亡。4例行Jatene手术,年龄从5个月至6岁不等,无死亡病例。22例三尖瓣闭锁患者接受了Fontan手术,2例早期死亡,无晚期死亡。术后平均心脏指数为2.6±0.6。心脏指数与术前肺动脉横截面积除以体表面积(PA指数)密切相关,但与右心房压力或左心室容积相关性较差。

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