Yagihara T, Kishimoto H, Isobe F, Yamamoto F, Nishigaki K, Matsuki O, Uemura H, Kamiya T, Kawashima Y
Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka, Japan.
J Thorac Cardiovasc Surg. 1994 Feb;107(2):351-8.
Since June 1987, 10 of 19 consecutive patients with atrioventricular and ventriculoarterial discordance (average age 4 +/- 2 years) had undergone a double switch operation with the morphologically left ventricle used as a systemic ventricle. There were two combinations of procedures. Atrial switch combined with arterial switch was used in two patients who had a normal pulmonary valve. Atrial switch combined with ventriculoarterial switch by Rastelli's procedure was used in eight patients with pulmonary stenosis or atresia and a large ventricular septal defect. One early death and two late deaths have occurred in a postoperative follow-up period of up to 4 years. Subsequent problems were mainly related to the results of atrial switch procedures in patients who had a small atrium because of low pulmonary flow, especially in patients with apicocaval juxtaposition. Our experience suggested that the double switch operation would open a new era of definitive surgical treatment in half of the patients with atrioventricular and ventriculoarterial discordance.
自1987年6月起，19例连续性房室和心室动脉不一致患者（平均年龄4±2岁）中有10例接受了双调转手术，术中以形态学上的左心室作为体循环心室。手术方式有两种组合。2例肺动脉瓣正常的患者采用心房调转联合动脉调转。8例有肺动脉狭窄或闭锁及大型室间隔缺损的患者采用心房调转联合Rastelli手术进行心室动脉调转。在长达4年的术后随访期内，发生了1例早期死亡和2例晚期死亡。后续问题主要与因肺血流量低导致心房较小的患者的心房调转手术结果有关，尤其是心尖-腔静脉并列的患者。我们的经验表明，双调转手术将为一半的房室和心室动脉不一致患者开启确定性手术治疗的新时代。
