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[大动脉完全转位修复术后再次手术]

[Reoperation after repair of complete transposition of the great arteries].

作者信息

Masuda M, Yasui H

机构信息

Department of cardiac Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.

出版信息

Nihon Geka Gakkai Zasshi. 1998 Feb;99(2):78-83.

PMID:9575500
Abstract

Atrial switch operation (Mustard operation, Senning operation). Rastelli operation, and arterial switch operation (Jatene operation) have been performed as definitive methods for the repair of complete transportation of the great arteries (TGA). Obstruction of the superior vena cavae and the pulmonary venous tract are common reasons for reoperation after the atrial switch operation. Stenosis of the extracardiac conduit is inevitable after the Rastelli operation is performed. Reconstruction of the right ventricular outflow tract using Danielson's procedures may eliminate the need for reoperation. The REV procedure at the time of initial operation may decrease the incidence of reoperation after the repair of TGA with a ventricular septal defect and left ventricular outflow tract obstruction. Pulmonary stenosis is the most common reason for reoperation after the arterial switch operation. Reconstruction of the pulmonary artery using pacifico's method or the single pantaloon patch technique with autologous pericardium is expected to reduce the occurrence rate of postoperative pulmonary stenosis. Postoperative aortic regurgitation is uncommon and is usually mild in grade. However, because the pulmonary sinus is shallow and fragile compared with the aortic sinus of Valsalva, the durability of neoaortic valves remains to be elucidated during long-term follow-up.

摘要

心房调转术(马斯塔德手术、森宁手术)、罗斯蒂利手术和动脉调转术(贾特内手术)已被作为完全性大动脉转位(TGA)修复的确定性方法施行。上腔静脉和肺静脉通路梗阻是心房调转术后再次手术的常见原因。施行罗斯蒂利手术后,心外管道狭窄不可避免。采用丹尼尔森手术方法重建右心室流出道可能无需再次手术。在初次手术时采用REV手术可能会降低合并室间隔缺损和左心室流出道梗阻的TGA修复术后再次手术的发生率。肺动脉狭窄是动脉调转术后再次手术的最常见原因。采用帕西菲科方法或自体心包单裤式补片技术重建肺动脉有望降低术后肺动脉狭窄的发生率。术后主动脉瓣反流不常见,且通常程度较轻。然而,由于与瓦尔萨尔瓦主动脉窦相比,肺动脉窦浅且脆弱,新主动脉瓣的耐久性在长期随访中仍有待阐明。

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