Webber S A, LeBlanc J G, Keeton B R, Salmon A P, Sandor G G, Lamb R K, Monro J L
Wessex Cardiothoracic Centre, Southampton, UK.
Eur J Cardiothorac Surg. 1995;9(9):515-20. doi: 10.1016/s1010-7940(95)80052-2.
It has been widely stated that pulmonary artery banding (PAB) is contraindicated in the setting of double inlet left ventricle with transposition of the great vessels (DILV/TGA), especially if aortic arch obstruction is present. We postulated that the poor results for this condition reflect the tendency to leave the band in place long-term without early recognition and relief of subaortic stenosis (SAS). Short-term PAB with early relief of SAS remains an attractive option compared to a neonatal "Norwood" strategy. We reviewed our results applying this approach to 18 consecutive infants presenting since 1980 with DILV/TGA and an obstructive anomaly of the aortic arch (coarctation 16, interruption or atresia 2). Four of the infants (22%) were considered to have important SAS at presentation. One underwent neonatal aortopulmonary connection and died. The remaining 17 patients underwent arch repair with PAB (median age 1.4 weeks; range 2 days-22 weeks) with one early death. The 16 survivors have been followed for 5.6 +/- 3.7 years. All but one ultimately developed SAS. Relief of SAS was performed in 15 patients (median age 8 months) using a proximal aortopulmonary anastomosis. There were two early deaths, and one late death. Thirteen of the 18 patients (72%) are alive and well, and 12 have achieved Fontan repair or bidirectional superior cavopulmonary anastomosis (BCPA) with persistent relief of SAS. Most patients with DILV/TGA and aortic arch obstruction will tolerate temporary PAB with adequate protection of the pulmonary vascular bed. Our current approach (in the absence of severe SAS at presentation) is PAB at the time of arch repair, followed by careful surveillance for, and early relief of, SAS combined with BCPA in infancy.
人们普遍认为，在合并大动脉转位的双入口左心室（DILV/TGA）情况下，尤其是存在主动脉弓梗阻时，肺动脉环缩术（PAB）是禁忌的。我们推测，这种情况下效果不佳反映出长期保留环缩带而未早期识别和解除主动脉瓣下狭窄（SAS）的倾向。与新生儿“诺伍德”策略相比，短期PAB并早期解除SAS仍然是一个有吸引力的选择。我们回顾了自1980年以来对18例连续出现DILV/TGA和主动脉弓梗阻性异常（16例缩窄，2例中断或闭锁）的婴儿应用该方法的结果。4例婴儿（22%）在就诊时被认为存在重要的SAS。1例接受了新生儿主肺动脉连接术，术后死亡。其余17例患者接受了PAB的主动脉弓修复术（中位年龄1.4周；范围2天至22周），1例早期死亡。16例幸存者随访了5.6±3.7年。除1例之外，所有患者最终均出现SAS。15例患者（中位年龄8个月）采用近端主肺动脉吻合术解除了SAS。有2例早期死亡和1例晚期死亡。18例患者中有13例（占72%）存活且情况良好，12例已完成Fontan修复术或双向腔肺吻合术（BCPA），SAS持续缓解。大多数DILV/TGA和主动脉弓梗阻患者能够耐受临时PAB，并对肺血管床有足够的保护。我们目前的方法（就诊时无严重SAS）是在主动脉弓修复时进行PAB，随后在婴儿期仔细监测并早期解除SAS，同时进行BCPA。
