Laohaprasitiporn D, Nana A, Soongswang J, Sriyoscharti S, Pornvirawan S, Prakanrattana U, Watthanaprakarnchai W, Kangkagate C
Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 1998 Nov;81(11):866-71.
The rapid two-stage arterial switch operation is an alternative therapy for patients with simple transposition of the great arteries who present beyond the neonatal period and have low left ventricular pressure. It provides normal ventricular function compared to the atrial switch operation. Between July 1994 and February 1997, there were 13 such infants who had rapid two-stage arterial switch operation performed at Siriraj Hospital. There was 1 late death (11 months after the operation). All 12 survivors (mean age 22.4 +/- 5.7 months) were clinically evaluated and had echocardiography performed at 14.8 +/- 4.9 months after the operation. All were asymptomatic. Echocardiogram revealed a residual small atrial septal defect (1 case), small ventricular septal defect (1 case), mild supravalvar neopulmonary stenosis (2 cases), bicuspid neoaortic valve without stenosis (2 cases), dilated neoaortic sinus of Valsalva (6 cases, 50%) and mild neoaortic insufficiency (11 cases, 91.7%). The left ventricular function was hyperdynamic after pulmonary artery banding and significantly decreased to normal level at the time of study (shortening fraction of 43.8 +/- 10.7 vs 29.2 +/- 3.8%, respectively, p = 0.0005). The wall thickness was significantly increased after pulmonary artery banding and decreased overtime (0.48 +/- 0.08 vs 0.32 +/- 0.05 cm, respectively, p < 0.0005). The left ventricular dimension was significantly increased both after pulmonary artery banding and at the time of study (2.06 +/- 0.42 vs 3.32 +/- 0.30 cm, respectively, p < 0.0005). The left ventricular mass was significantly increased after pulmonary artery banding and at the time of study (21.79 +/- 7.79 vs 33.08 +/- 7.40 g/m2, respectively, p = 0.0005). The mortality and morbidity of rapid two-stage arterial switch operation are low. However, long-term follow-up should be monitored.
快速两阶段动脉调转术是患有单纯性大动脉转位且在新生儿期后就诊、左心室压力较低的患者的一种替代治疗方法。与心房调转术相比，它能提供正常的心室功能。1994年7月至1997年2月期间，有13名此类婴儿在诗里拉吉医院接受了快速两阶段动脉调转术。有1例晚期死亡（术后11个月）。所有12名幸存者（平均年龄22.4±5.7个月）均接受了临床评估，并在术后14.8±4.9个月进行了超声心动图检查。所有人均无症状。超声心动图显示有残余小房间隔缺损（1例）、小室间隔缺损（1例）、轻度肺动脉瓣上狭窄（2例）、无狭窄的二叶式新主动脉瓣（2例）、扩张的新主动脉窦（6例，50%）和轻度新主动脉瓣关闭不全（11例，91.7%）。肺动脉环扎术后左心室功能亢进，在研究时显著降至正常水平（缩短分数分别为43.8±10.7%和29.2±3.8%，p = 0.0005）。肺动脉环扎术后室壁厚度显著增加，随时间推移而减小（分别为0.48±0.08 cm和0.32±0.05 cm，p < 0.0005）。肺动脉环扎术后和研究时左心室尺寸均显著增加（分别为2.06±0.42 cm和3.32±0.30 cm，p < 0.0005）。肺动脉环扎术后和研究时左心室质量均显著增加（分别为21.79±7.79 g/m²和33.08±7.40 g/m²，p = 0.0005）。快速两阶段动脉调转术的死亡率和发病率较低。然而，应进行长期随访监测。
