Reddy V M, McElhinney D B, Silverman N H, Hanley F L
Division of Cardiothoracic Surgery, University of California, San Francisco, USA.
Eur Heart J. 1997 Sep;18(9):1470-7. doi: 10.1093/oxfordjournals.eurheartj.a015474.
To assess outcomes of anatomical repair (double switch procedure) in infants and children with congenitally corrected transposition of the great arteries.
Between September 1993 and August 1996, 17 patients with congenitally corrected transposition underwent surgery at UCSF. Anatomical repair was performed in 11 of these patients, at ages ranging from 4.8 months to 7.8 years (median 3.2 years). The remaining six patients did not undergo anatomical repair due to unfavourable anatomy (n = 2), prior conduit repair (n = 2), biventricular dysfunction (n = 1), and isolated complete atrioventricular block (n = 1). The 11 patients who underwent anatomical repair make up the study group for the present report. All 11 patients had a malalignment ventricular septal defect, while pulmonary outflow tract obstruction was present in nine patients and significant tricuspid valve pathology or dysfunction was present in five. Anatomical repair was achieved with a Senning (n = 7) or a Mustard (n = 4) procedure combined with an arterial switch operation plus ventricular septal defect closure (n = 4), or a Rastelli procedure with left ventricle to aortic baffle and right ventricle to pulmonary artery conduit (n = 7). There was one early death and no patients developed surgical complete atrioventricular block. At a median follow-up of 22 months, there were no late deaths. Two patients required a total of three late reoperations, and all patients were asymptomatic on no cardiac medication. Follow-up echocardiography revealed normal biventricular function in all patients.
Anatomical repair of corrected transposition can be achieved with low rates of early mortality and surgical heart block, and favourable mid-term results. Long-term follow-up will be necessary to determine if the double switch approach improves the natural history of corrected transposition when compared to less aggressive surgical approaches that leave the right ventricle in the systemic circulation.
评估先天性矫正型大动脉转位婴幼儿及儿童行解剖修复术（双调转手术）的效果。
1993年9月至1996年8月期间，17例先天性矫正型大动脉转位患者在加州大学旧金山分校接受手术。其中11例患者接受了解剖修复术，年龄从4.8个月至7.8岁（中位年龄3.2岁）。其余6例患者因解剖结构不佳（n = 2）、既往行管道修复术（n = 2）、双心室功能障碍（n = 1）及孤立性完全性房室传导阻滞（n = 1）未接受解剖修复术。接受解剖修复术的11例患者构成了本报告的研究组。所有11例患者均有对位不良型室间隔缺损，9例患者存在肺动脉流出道梗阻，5例患者存在严重三尖瓣病变或功能障碍。解剖修复通过Senning术（n = 7）或Mustard术（n = 4）联合动脉调转术加室间隔缺损修补术（n = 4），或Rastelli术加左心室至主动脉挡板及右心室至肺动脉管道（n = 7）完成。有1例早期死亡，无患者发生手术性完全性房室传导阻滞。中位随访22个月时，无晚期死亡。2例患者共需要3次晚期再次手术，所有患者在未服用心脏药物的情况下均无症状。随访超声心动图显示所有患者双心室功能正常。
矫正型大动脉转位的解剖修复术可实现较低的早期死亡率和手术性心脏传导阻滞发生率，并获得良好的中期效果。与保留右心室在体循环的较保守手术方法相比，双调转术是否能改善矫正型大动脉转位的自然病程尚需长期随访来确定。
