心房及大动脉双调转术治疗先天性矫正型大动脉转位

目的 总结先天性矫正型大动脉转位心房及大动脉双调转术治疗的初步经验.方法 先天性矫正型大动脉转位行心房及大动脉双调转手术17例.8例行Senning+大动脉调转术,年龄11个月～11岁,中位年龄3.7岁,其中7例合并肺动脉高压,1例合并肺动脉瓣下狭窄,3例曾行肺动脉环缩术-左心室锻炼.9例行Senning+ Rastelli手术,年龄5～24 岁,中位年龄9.0岁,其中5例行室缺扩大术.结果 Senning+大动脉调转手术组主动脉阻断183～282 min,术后呼吸机辅助14～984 h,引流208～1496 ml.术后完全性房室传导阻滞1例,安装永久性心脏起搏器后病愈出院;右侧膈肌麻痹1例,行膈肌折叠术后病愈出院.Senning+ Rastelli手术组主动脉阻断132～380 min,术后呼吸机辅助18～276 h,引流108～1780 ml,术后ECMO辅助循环1例,因低心排综合征死亡1例.结论 对于年龄较大的先天性矫正型大动脉转位病儿,心房及大动脉双调转术近期治疗效果满意.

Double-Switch operation for Corrected transposition of the great arteries

Objective To summarize our preliminary experience of double-switch operation for patients with congenitally corrected transposition of the great arteries.Methods The data of 17 patients with congenitally corrected transposition of the great arteries that had procedures of double-switch operation between November 2001 and July 2006 were retrospectively reviewed.Eight patients,including one patient with moderate pulmonary stenosis,underwent an arterial switch operation (ASO) combined with a Senning procedure while the other nine patients with moderate or severe pulmonary stenosis underwent combined Rastelli and Senning procedures.Before the double switch,three patients had required pulmonary artery banding for left ventricular training.Results (1) Senning+ ASO:aortic crossclamping time was 183～282 minutes,postoperative mechanical ventilation time was 14～984 hours,amount of drainage was 208～1496 ml.The in-hospital complications included third degree A-V block in 1 patient and right diaphragmatic paralysis in 1 patient.(2) Senning+ Rastelli:aortic crossclamping time was 132～380 minutes,postoperative mechanical ventilation time was 18～276 hours,amount of drainage was 108～1780 ml.The in-hospital complication was pulmonary hypertensive crisis in 1 patient.There was 1 hospital-death of low cardiac output syndrome.Conclusion Double-switch operation can provide satisfactory short-term outcomes for elder patients with congenitally corrected transposition of the great arteries.