单个瓣窦发出冠状动脉的大动脉调转术

目的 评估单个瓣窦发出冠状动脉(CA)的大动脉调转术(ASO)手术效果.方法 1999年3月至2006年6月共行单个瓣窦发出冠脉的ASO 31例.包括完全性大动脉错位(TGA)伴室间隔缺损(VSD)27例,室间隔完整(IVS)的TGA 4例.其中单根CA开口于右瓣窦4例;LCA和RCA分别开口于右瓣窦15例;LCA在壁内走行与RCA分别开口于右瓣窦4例;单根CA开口于左瓣窦8例.术中采用冠状动脉button用"开门"或向后翻转90°,加心包片或动脉壁扩大的方法移植于新的主动脉根部.结果 术后死亡8例,病死率25.8%.随访2～5 年,2例残余分流自愈,2例肺动脉残余梗阻(压差30、56 mm Hg),所有病婴均无明显心肌缺血改变.结论 冠状动脉畸形移植是一种切实可行和减少移植后冠状动脉扭曲和变形的方法,并能减少术后心肌缺血,提高手术成功率.

Arterial switch operation for complete transposition of the great arteries with coronary artery from single sinus

Objective Objective Successful transfer of the coronary arteries is the most critical step during arterial switch operations (ASO) for patients with transposition of the great arteries (D-TGA) with coronary artery (CA) from singie sinus.Various techniques have been reported.The present study evaluated the results of 31 cases.Methods 31 babies with D-TGA were repaired with the ASO including 27 cases of D-TGA with ventricular septal defect (VSD) and 4 cases of D-TGA with intact ventricular septal (IVS).For CA anomalies,there were 12 patients with singie CA ostium originating from sinus Ⅰ or sinus Ⅱ,15 patients with right CA and left CA ostium originating from sinus Ⅱ.The 90-degree coronary patch turn and "trap door" techniques were used.Results The mortality rate was 25.8%.No CA perfusion abnormality was observed.In the postoperative following-up,there were 2 patients with residual VSD,which closed naturally during 1-2 years,and 2 patients with residual pulmonary stenosis.Conclusion Transfer of the coronary button by the 90-degree coronary patch turn with the pericardial or and "trap door" techniques.Pericardial or pulmonary artery hood augmentation to the previously anastomosed neo-aorta as suggested as a practical,easy and convenient combination.