动脉转位术的临床应用

目的 总结动脉转位术(arterial switch operation，ASO)治疗完全型大动脉转位(transposition of the great arteries，TGA)和右心室双出口伴肺动脉瓣下室间隔缺损(VSD)的临床经验。方法 采用ASO治疗小儿先天性心脏病32例，其中TGA22例，伴室间隔完整型(intact ventricular septum，IVS)9例，伴VSDl3例；右心室双出口伴肺动脉瓣下VSD(Taussig—Bing)10例。结果TGA／IVS9例中死亡1例，TGA／VSD13例中死亡4例，Taussig-Bing10例死亡3例，总手术死亡率25％(8／32)。术后随访3个月～2年，所有患者紫绀消失，活动能力明显增强。1例Taussig—Bing术前二尖瓣轻-中度反流，术后仍为中度反流；2例TGA主动脉和肺动脉瓣上狭窄，压差40mmHg(1kPa=7．5mmHg)，1例肺动脉瓣下狭窄和残余VSD，3个月后再次手术治愈。结论 ASO已广泛应用于TGA的纠治，手术效果满意；应用于右心室双出口肺动脉瓣下VSD的早期纠治，不但可防止发生肺血管阻塞性病变，而且避免了心内修补左心室流出道梗阻的远期并发症。

Clinical application of arterial switch operation

Objective To summarize clinical experience of arterial switch operation(ASO). Methods Thirty-two patients with congenital heart disease were repaired by ASO from November, 1999 to December,2001. There were 9 patients with complete transposition of the great arteries and intact ventricular septum (TGA/IVS), 13 patients with complete transposition of the great arteries and ventricular septal defect (TGA/VSD) and 10 patients with double outlet right ventricle with subpulmonary ventricular septal defect (Taussig-Bing). Results There were 1 deaths in TGA/IVS, 4 deaths in TGA/VSD and 3 deaths in Taussig- Bing. The total operative mortality was 25%(8/32). All patients were followed-up 3 months to 2 years. Postoperatively there were one patient with Taussig-Bing had moderate mitral valve regurgitation, 2 patients had supravalvar stenosis of aorta and pulmonary artery. One patient with subpulmonary stenosis and residual VSD, which was reoperated after 3 months. Conclusions The ASO is widely used in TGA and has a satisfactory results. It also be used in Taussig-Bing to prevent pulmonary hypertension and avoid late complication from intraventricular repair of ventricular outflow tract obstruction.