快速与长期双期大动脉调转术在室间隔完整大动脉转位中应用的对比研究

目的通过比较快速和长期双期大动脉调转术(ASO)的组间特点,总结发生左室退化后室间隔完整大动脉转位(TGA-IVS)的手术治疗经验。方法纳入2007年1月至2019年1月主要诊断为TGA-IVS并行双期ASO的患儿41例,其中男25例、女16例,平均年龄17.9个月(7 d至7岁)。根据双期手术间隔时间,分为快速双期ASO组(19例)和长期双期ASO组(22例)。比较两组患儿临床效果。结果两组患儿的年龄、体重、ASO术前血氧饱和度、训练术前左室舒张期末内径、ASO术前左室后壁厚度差异均有统计学意义(P<0.05)。患儿年龄>1岁是进行长期双期ASO的独立危险因素。结论长期双期ASO对年龄>1岁和左心室退化严重的患儿具有良好的疗效。     

远隔节段跳跃型胸椎管狭窄症一期手术与分期手术的临床疗效观察

目的 :回顾性研究远隔节段跳跃型胸椎管狭窄症的一期手术和分期手术治疗效果,为远隔节段跳跃型胸椎管狭窄症手术治疗提供依据。方法:回顾性分析2005年1月~2016年6月期间于我院治疗的远隔节段跳跃型胸椎管狭窄症患者34例,其中男18例,女16例,确诊时年龄37~80岁,平均52.8±10.9岁。病程1~120个月,平均22.5±28.1个月。根据患者的手术方案,将患者分为一期手术与分期手术组,比较两组患者术前及末次随访JOA评分及改善情况、手术情况(出血量、手术时间)、术后住院时长及并发症情况。结果:一期手术组15例;分期手术组19例。随访时间为11~113个月,平均40.0±29.7个月。两组JOA评分术前分别为4.7±1.1分、4.3±2.2分,末次随访时分别为8.4±1.1分、7.5±2.0分,平均改善率分别为(57.1±21.6)%、(46.0±25.8)%,两组间上述参数比较差异均无统计学意义。两组平均手术时长分别为166.8±50.3min、326.6±121.8min,手术平均失血量分别为484.0±286.1ml、1694.2±1532.4ml,两组手术时间及手术失血量均有统计学差异(P0.01)。两组术后平均总住院时间分别为7.5±4.0d、19.9±8.7d,有统计学差异(P0.01)。根据手术疗效评定标准,一期手术组术后优良率60.0%,分期手术组术后优良率52.6%,两组优良率比较无统计学差异。分期手术组当中,手术间隔1年以内和1年以上,术后效果无明显统计学差异。术后共14例(41.2%)发生脑脊液漏(cerebrospinal fluid leakage,CSFL),其中一期手术组5例,分期手术组9例。共有10例(29.4%)发生其他方面并发症,其中一期手术组4例,分期手术组6例。两组在CSFL及其他并发症发生率方面统计学无明显差异。结论:远隔节段跳跃型胸椎管狭窄症患者可采用一期手术和分期手术。对于涉及的手术复杂程度低和身体状态好者,可选择一期手术;反之,建议分期手术。按上述既定方案,两组术后疗效及并发症发生率均无明显区别。     

一期手术与分期手术治疗Pilon骨折的疗效比较

目的比较一期切开复位内固定与一期外固定架固定、二期切开复位内固定治疗Pilon骨折的疗效。方法回顾性分析自2015-01—2018-01诊治的36例Pilon骨折,20例受伤24 h内一期行切开复位内固定手术(一期手术组);16例受伤24 h内行Ilizarov环形外固定架固定,待软组织肿胀消退后二期行切开复位内固定手术(分期手术组)。结果 30例获得随访,一期手术组16例,分期手术组14例;随访时间15~36个月,平均21.3个月。所有患者均无骨髓炎、皮肤坏死、创伤性关节等并发症发生。一期手术组与分期手术组患者主观满意度评价结果差异不大,骨折复位质量、末次随访时踝关节功能AOFAS评分与疼痛VAS评分比较差异无统计学意义(P>0.05)。结论一期手术与分期手术治疗Pilon骨折均可取得满意的疗效,但伤后24 h内一期切开复位内固定可减少住院时间与医疗费用,患者满意度更高。     

输尿管软镜治疗双侧上尿路结石一期与多期的疗效比较

目的探讨输尿管软镜治疗双侧上尿路结石一期与分期手术的临床疗效评估。方法收集本院2014年1月至2017年1月治疗的术前总肾功能正常的双侧上尿路结石患者,随机分为一期手术治疗患者43例(一期组),分期治疗患者55例(分期组);比较一期组同分期组患者总手术时间、总住院时间、结石清除率、并发症发生率、总费用。结果一期手术中转分期手术3例,术式改变率6.97%,分期手术均顺利完成手术;一期手术组总手术时间同分期手术组差异无统计学意义[(138.5±21.0)min vs.(128.6±27.3)min,P>0.05],一期组总住院时间较分期组总住院时间明显较短[(3.5±1.8)d vs.(7.6±3.5)d,P<0.05];两组患者分别于术后第4周复查泌尿系CT评估结石清除率分别为(84.73±3.51)%、(91.52±3.13)%。差异具有统计学意义(P<0.05);两组术后并发症发生率无统计学意义(P>0.05);总费用一期手术较分期手术节约1/3,存在明显差异。结论双侧上尿路结石输尿管软镜一期钬激光碎石术安全、有效,较分期治疗明显节约医疗成本,但需严格把握手术适应证。     

保留后瓣及瓣下结构的二尖瓣置换术

目的总结保留后瓣及瓣下结构的二尖瓣置换术(MVR)的临床经验,并观察其与常规MVR比较的临床效果。方法风湿性心瓣膜病患者54例,其中行保留后瓣及瓣下结构的MVR24例(保留二尖瓣后瓣组),行常规MVR30例(常规手术组),观察两组患者术前、术后3个月的左心室舒张期末内径(LVEDD)、左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)等指标。结果保留二尖瓣后瓣组无死亡患者,常规手术组死亡1例;保留二尖瓣后瓣组术后血管活性药物的用量、种类和呼吸机使用时间较常规手术组减少;术后3个月保留二尖瓣后瓣组LVEDD较常规手术组减小,LVEF较常规手术组增大(P<0.05)。结论保留后瓣及瓣下结构的MVR手术操作不复杂,不增加心内手术时间,有可能减少左心室破裂的危险,术中操作仔细可以避免卡瓣,术后心功能恢复较好,更适用于心功能较差、左心室较大的以二尖瓣关闭不全为主的患者。     

低磨损关节型骨水泥间隔器在75岁以上膝关节置换术后感染患者中的应用

目的探讨低磨损关节型骨水泥间隔器在75岁以上膝关节置换术后深度感染患者治疗中的作用,明确低磨损关节型骨水泥间隔器的临床疗效和使用价值。方法回顾性分析我院自2015年6月到2018年6月因膝关节置换术后深度感染行关节型抗生素骨水泥间隔器的12例患者资料,其中男4例,女8例;年龄76～83岁,平均(78.33±2.19)岁;老年患者9例,高龄患者3例。统计患者术前、术后1周、2周、3个月及末次随访时的膝关节活动度(range of motion,ROM)和美国特种外科医院(the hospital special surgery,HSS)评分。结果 12例患者均获得随访,随访时间31～55个月,平均(36.58±8.85)个月;9例患者行二期翻修手术,二期翻修术后随访时间16～48个月,平均(31.56±9.28)个月。未行二期翻修手术的3例患者中,1例患者因内脑血栓死亡,带间隔器生存时间为(27.67±7.23)个月。行二期翻修手术的9例患者中,1例患者因肺癌死亡,带间隔器生存时间为(8±3.16)个月。12例患者间隔器均未出现断裂或脱位情况,一期术前ROM(66.67±9.85)°,带间隔器期间ROM(93.75±3.77)°,两者比较差异有统计学意义(Z=-4.204,P0.05)。9例行二期翻修术后ROM(93.33±4.33)°,带间隔器期和二期翻修术后的ROM比较差异无统计学意义(Z=-0.347,P0.05)。12例患者一期手术前膝关节HSS评分平均(52.22±5.71)分;带间隔器期间膝关节HSS评分(81.34±2.84)分,行二期翻修手术患者术后膝关节HSS评分(82.93±1.64)分。一期术前和带间隔器期膝关节HSS评分两组间差异有统计学意义(Z=-4.158,P0.05);带间隔器期和二期翻修手术术后膝关节HSS评分两组间差异无统计学意义(Z=-1.425,P0.05)。结论低磨损关节型骨水泥间隔器可以有效控制膝关节深度感染和保留良好的膝关节功能,临床上二期翻修手术时间可以适当延后,给予老年患者机体充足的恢复时间;对于不适合行二期翻修手术或者拒绝再次手术且活动量少的高龄患者可以将其作为临时替代治疗。     

二期手术治疗完全性大动脉错位

目的　总结完全性大动脉错位 (D -TGA)二期手术治疗效果和经验。方法　回顾分析1990年 8月至 2 0 0 0年 12月间 8例进行二期手术D TGA病儿。二期手术年龄为 14d～ 96个月 ,平均(5 0 5± 32 4 )个月 ;体重为 3 7～ 2 3 5kg ,平均 (15 9± 6 1)kg。两次手术间隔时间为 3d～ 75个月。初期手术中球囊房间隔缺损扩张术 2例 ,伴肺动脉发育不良行Blalock Taussig分流术 2例 ;因肺动脉高压行肺动脉环缩术 (PAB) 4例。二期手术中Senning手术 1例 ,Rastelli手术 4例 ,大动脉转换术 (ASO) 2例 ,改良Fontan手术 1例。结果　手术早期死亡 2例 ,1例为Rastelli手术 ,另 1例为改良Fontan手术 ,死亡原因分别为器质性肺动脉高压和左室流出道梗阻。早期生存 6例 ,随访发现 ,Senning手术病儿三尖瓣轻度反流 ,心胸比率 0 6 ;3例Rastelli手术者无左、右室流出道梗阻 ,心功能良好 ,III度房室传导阻滞 1例 ,完全性右束支传导阻滞 2例 ;ASO 2例均无解剖问题 ,心功能正常 ,远期效果满意。结论　初期姑息手术可以对完全大动脉错位病儿的生理进行初步“调整”或“准备” ;二期手术尽量选择大动脉转换术 ,由于解剖或生理因素可选择Rastelli手术或Senning手术 ,避免改良Fontan手术。     

手术治疗肺动脉闭锁伴室间隔缺损合并主肺侧枝动脉患者的远期预后

目的探讨肺动脉闭锁伴室间隔缺损(PA-VSD)合并主肺侧枝动脉(MAPCAs)患者的外科治疗方案及其对远期预后的影响。方法回顾性分析上海交通大学医学院附属上海儿童医学中心2001年2月至2010年2月收治的29例PA-VSD合并MAPCAs患者的临床资料。其中一期根治手术组13例,男8例,女5例;年龄8～168(26.0±17.0)个月;分期手术组16例,男9例,女7例;年龄4～149(26.5±15.8)个月,其中8例行二期根治术,手术间隔时间14～40(28.3±11.7)个月。MAPCAs患者行单源化手术9例,结扎或心导管封堵16例,保持开放或旷置4例。比较两组患者院内死亡率、并发症发生率、术后中远期随访结果。采用《儿童生活质量测定量表4.0》评价两组患者生活质量,以29例PA-VSD为PA-VSD患者组,以本市某幼儿园100名普通幼儿为对照组。结果一期根治手术组与分期手术组术院内死亡率差异有统计学意义[15.4%(2/13)vs.0.0%,χ2=4.12,P=0.04],两组并发症发生率差异无统计学意义[76.9%(10/13)vs.68.7%(11/16),χ2=0.51,P=0.47]。术后随访3～88个月,结果显示,一期根治手术和分期手术组患者病死率差异也无统计学意义[27.3%(3/11)vs.6.2%(1/16),χ2=2.28,P=0.13],一期根治手术组与分期手术组患者的生活质量总体评分差异无统计学意义[(66.7±8.6)分vs.(70.2±13.0)分,t=-0.71,P=0.48],而PA-VSD患者组与对照组生活质量总体评分差异有统计学意义[(68.7±11.2)分vs.(77.8±15.7)分,t=3.14,P=0.01],主要体现在生理评分差异有统计学意义[(57.7±11.7)分vs.(83.0±19.6)分,t=5.67,P=0.00],而PA-VSD患者组与对照组在情感、社交、学校表现领域评分差异均无统计学意义。结论依据患者肺动脉形态和临床状况个体化选择分期手术方案并对MAPCAs做恰当处理,是降低PA-VSD合并MAPCAs患者手术死亡率和并发症发生率的关键。     

二尖瓣脱垂微创修复手术后左心室结构和功能改变

目的运用超声心动图技术及其对左心室舒张功能的分级评估二尖瓣微创修复手术纠治单纯二尖瓣脱垂患者左心室结构和功能的变化。方法纳入2016年1月至2017年5月在我院心胸外科接受二尖瓣微创修复术的单纯二尖瓣脱垂患者37例作为手术组,其中男25例、女12例,年龄(53.49±11.02)岁。另选择年龄、性别与之相匹配的34例正常体检者为对照组,其中男19例、女15例,年龄(54.26±8.33)岁。回顾性分析术前及术后1个月、3个月、6个月、1年的心脏超声数据,计算心功能参数并对左心室舒张功能分级,通过组间两两比较分析术后患者在左心结构和功能的改善情况。结果手术组患者术后左心室收缩、舒张期末内径,左心房内径、左心室容积较术前显著缩小;术后左心室和左心房的内径较术前显著缩小,但大于对照组;术后1个月射血分数较术前显著降低,随后恢复至正常水平;术后6个月和1年左心室舒张功能不全发生率显著低于术前,差异均有统计学意义(P0.05)。结论单纯二尖瓣脱垂患者行微创修复术后,左心房、左心室结构重构的同时左心室收缩和舒张功能也有显著改善。     

一期与分期输尿管软镜治疗双侧上尿路结石的疗效比较

目的探讨一期与分期输尿管软镜下碎石术(flexible ureteroscopic lithotripsy,FURL)治疗双侧上尿路结石的临床疗效。方法我院2012年9月~2015年5月一期输尿管软镜下钬激光碎石术治疗双侧上尿路结石29例(一期手术组),分期输尿管软镜治疗双侧上尿路结石20例(分期手术组),比较2组总手术时间、总住院时间、结石清除率、并发症发生率。结果 2组患者均顺利完成手术。一期手术组总手术时间明显短于分期手术组[(71.0±19.0)min vs.(112.6±26.8)min,t=-6.366,P=0.000],2组总住院时间无统计学差异[(6.9±3.6)d vs.(8.4±2.1)d,t=-1.674,P=0.101]。2组患者术后4周结石清除率分别为79.3%(23/29)、80.0%(16/20),无统计学差异(χ~2=0.000,P=1.000);2组术后并发症发生率无统计学差异[20.7%(6/29)vs.15.0%(3/20),χ~2=0.017,P=0.896]。结论一期双侧输尿管软镜钬激光碎石术可有效、安全治疗双侧上尿路结石,但仍需严格把握手术适应证。     

Primary Arterial Switch Operation for Late Presentation of Transposition of the Great Arteries With Intact Ventricular Septum

TGA-IVS with late presentation (>21 days) managed with primary ASO despite the LV deconditioning. Unfavorable TGA-IVS with severely deconditioned LV showed similar outcomes compared to favorable TGA-IVS with the recovery of LV mass, excellent survival but higher use of ECMO support. ASO: arterial switch operation, LV: left ventricle, TGA-IVS: transposition of the great arteries with intact ventricular septum

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大动脉转换术在复杂先天性心脏病治疗中的应用

目的 回顾总结我院近3年采用大动脉转换术治疗小儿复杂先天性心脏病(先心病)的临床经验。方法2000年1月至2003年5月,采用大动脉转换术(Switch手术)治疗小儿复杂先心病61例。其中完全性大血管错位(TGA)45例,包括室间隔完整型(TFGA-IVS)26例,伴室间隔缺损(TGA,VSD)19例;右心室双出口伴肺动脉瓣下室间隔缺损(Taussig-Bing)16例。结果TGA,IVS死亡2例;TGA-VSD死亡4例;Taussig-Bing死亡4例;总手术病死率16％。术后随访3个月-3年,所有病例青紫症状消失,活动能力明显增强。1例Taussig-Bing术前二尖瓣轻～中度返流,术后仍为中度返流。2例TGA术后出现主动脉和肺动脉瓣上狭窄,压差40mmHg,1例肺动脉瓣下狭窄和残余室间隔缺损,3个月后再次手术治愈。结论大动脉转换术应用于完全性大血管错位的纠治,手术效果满意;应用于右室双出口肺动脉瓣下室间隔缺损的纠治,不但可早期纠治,防止其肺血管阻塞性病变发生,而且避免了心内修补左室流出道梗阻的远期并发症。     

D-Transposition of great vessels with intact ventricular septum presenting at 3–8 weeks: Should all go for rapid two stage arterial switch or primary arterial switch?

Background Current reports favour primary arterial switch (ASO) in infants with d-transposition of great vessels (d-TGA) with intact ventricular septum (IVS) who present later than 21 days. The premise is that the regressed left ventricle (LV) will still adapt to the systemic circulation. Methods We compared a retrospective group of 11 infants (group A) who had undergone rapid two stage ASO with those (group B) who had undergone primary ASO (n=15). Results The age range (25–70 days), weight (2.5–4.0 Kg), posterior wall thickness of LV (2.8 mm–4.2 mm) and other pre-operative criteria were similar in both groups. In group A, 3/11 infants died after first stage, one each due to shunt blockade, tight pulmonary artery band, and after emergency Senning operation following cardiac failure. Of the remaining eight who underwent ASO 5–9 days after first stage, three died, one each due to fungal infection, sepsis and multi-organ failure, and massive haemorrhage from internal mammary artery. Success of LV training was 8/11 (73%) while overall survival was 5/11 (45%). In group B (15 infants), 13 survived (86%), two needing post-operative extracorporeal membrane oxygenator (ECMO) support and two deaths occurred due to immediate post-operative cardiac failure. Conclusions This study demonstrates that primary ASO can show benefit in infants of d-TGA with IVS presenting between 21 to 60 days of age as compared to rapid two stage ASO. These infants might need more support for the ventricular function in form of prolonged inotropes and ECMO support.     

Surgical management of transposition of the great arteries

From January 1983 through December 1991 470 patients underwent an arterial switch operation (ASO). 281 (59.7%) had transposition of the great arteries (TGA) with intact ventricular septum (IVS) and 189 (40.3%) had a ventricular septal defect (VSD). The overall hospital mortality for ASO was 6.3%, but 0.6% (1/155) in the last 155 consecutive patients with TGA/IVS. Of 9 late deaths (1.9%) 5 were due to coronary artery obstruction. 2 were found related to pulmonary vascular obstructive disease and 2 were unrelated to ASO. Cardiac catheterization in 244 late survivors revealed postoperative, supravalvular pulmonary stenosis in 2% of patients. Residual shunts on ventricular levels greater than QP/QS=1.5/1.0 were measured in 4 patients. No regional wall motion abnormalities were detected and left ventricular function appeared normal in all patients 2 years after surgery. One year after surgery 98% of patients presented in sinus rhythm. The favourable early and midterm results of the ASO as a primary operation continue to make it the preferred approach for the neonate with TGA/IVS and TGA/VSD whenever possible. The rapid two-stage approach (preliminary pulmonary artery banding and shunt followed by ASO after 7 days) is applicable for older patients with TGA/IVS.     

Thrombus formation in the heart following balloon atrial septostomy in transposition of great arteries

Thrombotic complications following balloon atrial septostomy (BAS) are unusual. We report a patient with thrombus formation at the site of BAS, extending into the inferior vena cava (IVC), following BAS for transposition of great arteries with intact ventricular septum (TGA-IVS). An urgent arterial switch operation (ASO) with removal of the thrombus was performed.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12055-022-01331-4.     

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。     

Transposition of the great arteries with intact ventricular septum. Arterial switch in the first month of life

Twenty-three infants with simple transposition of the great arteries and intact ventricular septum were operated on from October 1983 to October 1986. The age at operation in 22 infants ranged from 2 to 21 days and in one was 35 days (mean 9.82 +/- 6.86 days). The infants were evaluated with cardiac catheterization at 1 to 27 days of age. Twenty-two infants had balloon atrial septostomy, and 22 received prostaglandin E1 infusion. The left ventricular diastolic wall thickness, assessed by M-mode echocardiograms, varied between 2.8 and 4 mm. There were two hospital deaths in this group of 23 infants (mortality 8.6%), and there were no late deaths. All surviving patients are doing well clinically. One patient had asymptomatic nonsustained ventricular tachycardia necessitating phenytoin. Postoperative echocardiographic assessment performed on 15 patients at 0.93 +/- 0.61 years of age and cardiac catheterization and angiographic studies on seven patients at 1.07 +/- 0.13 years after operation revealed excellent ventricular performance, good semilunar valve function, and mild gradient at the right ventricular outflow with a mean right ventricular pressure of 37.4 +/- 4.1 torr.     

Primary arterial switch operation in children presenting late with d-transposition of great arteries and intact ventricular septum. When is it too late for a primary arterial switch operation?

Objective: The surgical management of infants older than 2 weeks with d-transposition of great arteries and intact ventricular septum (IVS) is a matter of debate. Some studies have presented good results of primary arterial switch operation (ASO) in these children. The aim of this study was to assess the surgical outcome of the primary ASO in children with d-transposition of great arteries and IVS presenting beyond 6 weeks of age. Methods: The clinical records of the children (more than 6 weeks age) with d-transposition of great arteries and IVS, who underwent primary ASO at our institute between January 2003 and June 2009 were reviewed. Left ventricular geometry and interventricular septal motion on the transthoracic cross-sectional echocardiogram were taken to assess the left ventricle preparedness. Results: Fifty-five children (age ranging from 42 days to 9 years) with d-transposition of great arteries and IVS underwent primary ASO. The mean cardiopulmonary bypass time was 94.7 ± 21.3 min, while mean aortic cross-clamp time was 53.2 ± 8.1 min. Seven (13%) of these children died during their hospital stay. The children who had severely regressed left ventricle (banana-shaped left ventricular geometry) were operated with integrated extra corporeal membrane oxygenation–cardiopulmonary bypass (ECMO–CPB) circuit for left ventricular re-training. The children with regressed left ventricle required longer ventilatory time and inotropic support. Recovery of left ventricular geometry has taken 1–6 months depending on age at surgery. Conclusions: The children older than 6 weeks with d-transposition of great arteries and IVS can benefit from primary ASO with acceptable results. However, the need for mechanical support in some of the older patients may limit the widespread adoption of such a strategy.     

Early and midterm results of the arterial switch operation for transposition of the great arteries in Japan

A total of 267 infants and children who underwent the arterial switch operation for transposition of the great arteries in the 6 years before Jan. 1, 1988 in six main Japanese institutions were entered into this review. The current status of patients surviving more than 1 year after the operation were evaluated along with early operative results. One hundred forty-six patients had an intact ventricular septum, 103 had a significant ventricular septal defect, and 18 had so-called Taussig-Bing anomaly of the transposition type. Eighteen patients were less than 28 days of age, 73 were 1 to 5 months of age, and 176 were older than 6 months of age at the time of operation. The overall mortality rate was 35% in the first 3 years and 12% in the more recent 3 years. There was a significant difference between the overall mortality rate of primary and two-stage repair (22% versus 10%, p = 0.047) in patients with intact ventricular septum. The overall mortality rate in patients with type B or C coronary arteries of Yacoub, and Radley-Smith's classification was significantly higher than that of other types of arteries (86% versus 18%, p = 0.0001). A total of 156 patients survived more than 1 year after the operation, and 44 children (28%) were noted to have supravalvular pulmonary stenosis (greater than 20 mm Hg). This complication was more common in patients operated on in the newborn period. Trivial or mild aortic regurgitation was noted in 29 patients (19%) and was more common in patients with two-stage than with primary repair (24% versus 14%). Aortic regurgitation was significantly more prevalent in patients in whom coronary arteries were implanted into slits or U-shaped defects than in those whose arteries were implanted into punched-out holes made on the pulmonary root (28% versus 8%, p = 0.049). Normal sinus rhythm was present in 97% of 154 patients and left ventricular ejection fraction was within the normal range in 97% of 115 patients at catheterization 1 to 5 months after the operation.