首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到16条相似文献,搜索用时 93 毫秒
1.
目的 总结完全性大动脉转位行快速二期大动脉转位术的左心室功能锻炼结果,探讨判断左心功能锻炼效果的指标和二期大动脉转位术的最佳手术时机.方法 2002年9月至2007年9月21例患者接受快速二期大动脉转位术.其中男性13例,女性8例;手术年龄29~250 d,中位数75 d,平均(103±69)d;体质量3.5~7.0 kg,中位数5.0 kg,平均(5.0±1.2)kg.所有患者先行一期左心功能锻炼术,术后常规隔天复查床旁超声心动图.测量左心室舒张末期内径、左心室后壁舒张期厚度和舒张期室间隔厚度,根据公式计算左心室质量和左心室质量指数.结果 两次手术平均间隔(9±5)d.一期术后,左右心室压力比从术前的0.47±0.15上升至0.91±0.20(P<0.01).左心室质量指数从(30±11)g/m2上升至(63±20)g/m2(P<0.01).一期术前与二期大动脉转位术前的左心室舒张末期内径、左心室舒张末期容积、左心室后壁舒张期厚度以及舒张期室间隔厚度,差异有统计学意义(P<0.05).结论 左心功能退化的完全性大动脉转位患者,经左心室锻炼术后左心功能可得到锻炼恢复.左心功能锻炼期的时间为7~10 d.左右心室压力比大于0.65,左心室质量指数50g/m2是判断左心功能锻炼结果的主要指标.
Abstract:
Objectives To Summarize the results of left ventricle retraining in rapid two-stage switch operation and to determine the estimating index of left ventricle retraining and the best time of the second stage operation. Methods From September 2002 to September 2007, 21 patients underwent rapid two stage switch operation. There were 13 male and 8 female patients, ageing from 29 to 250 d [mean ( 103±69) d, median 75 d], weighting from 3.5 to 7.0kg [mean (5.0 + 1. 2) kg, median 5.0 kg]. After pulmonary band, bedside echocardiography was regularly done every other day. Paired t-test was used to analyze the changes of left ventricular end-diastolic dimension ( LVDd ), left ventricular posterior wall dimensions ( LVPWd), diastolic intra-ventricular septal dimensions ( IVSd), left ventricular (LV) mass and LV mass indexed for body surface area. Results The mean interval was ( 9 + 5 ) d. After the left ventricle preparative operation, the left ventricular to right ventricular pressure ratio (pLV/RV) raised from 0.47 +0. 15 to 0.91 ±0.20 (P<0.01). LV mass indexed for body surface area raised from (30+11) g/m2 to (60±20) g/m2(P<0.01). Extremely significant difference of LV mass existed between pre-arterial switch operation and pre-left ventride preparative operation, and significant difference existed in LVDd,LVDd3, LVPWd and IVSd between the two operative timing points. Conclusions The left ventricular function of the transposition of the great arteries can be retraining by the left ventride preparative operation. The interval of left ventricle retraining should be controlled in 7 to 10 d, and the pLV/RV reach 0. 65 and the LV mass index over 50 g/m2 are two important indicators of the second stage operation of arterial switch operation.  相似文献   

2.
目的 总结年龄大于6个月的伴室间隔缺损合并重度肺动脉高压完全性大动脉转位患儿诊断性治疗-根治性手术策略的应用经验及术后效果,探讨手术指征.方法 2010年1月至2011年10月手术治疗17例伴室间隔缺损合并重度肺动脉高压完全性大动脉转位患儿,男13例,女4例.中位年龄1.2岁,其中0.5岁~<1.0岁6例,≥1.0岁~<3.0岁3例,≥3.0岁8例.合并动脉导管未闭6例,房间隔缺损5例,二尖瓣关闭不全2例,肺动脉瓣轻度狭窄2例.术前均行超声心动图检查,冠状动脉CT检查11例,右心导管检查3例.全组均行诊断性治疗2~4周,静吸复合麻醉低温体外循环下行大动脉调转术(ASO),术后残留肺动脉高压者继续予肺动脉高压靶向药物治疗.结果 全组无手术死亡.术前经诊断性治疗动脉氧饱和度提高10% ~21%,肺动脉平均压下降10 ~20mmHg(1.33 ~2.67kPa).随访6~32个月,平均11.2个月.随访期间1例死于食物中毒致急性腹泻、电解质紊乱和心律失常,余患儿至最终随访日均生存.术后6例(35.29%)残余肺动脉高压,年龄均≥3岁,肺动脉高压靶向药物治疗6 ~20个月后,肺动脉压力明显下降.结论 大于6个月的伴室间隔缺损肺动脉高压完全性大动脉转位患儿经诊断性治疗后可以选择性实施根治性手术(ASO),效果良好.  相似文献   

3.
完全性大动脉错位(D-TGA)约占先天性心脏病(先心病)的5%,是新生儿期常见、易发生心力衰竭、病死率最高的紫绀型先心病。病婴的主动脉起自右心室,肺动脉起自左心室,体肺循环成并列循环状态,肺循环的氧合血不能有效地进入体循环。病婴出生后,因体循环血氧饱和度过低,发生缺氧、酸中毒死亡。文献报道,若未及时行外科治疗,完全性大动脉错位室间隔完整(TGA-IVS)病婴1个月内的病死率为50%,90%的病婴将在1岁以内死亡。大动脉转位术(ASO)是纠治的最佳手术方案。[第一段]  相似文献   

4.
快速二期大动脉转位术早期死亡危险因素   总被引:1,自引:0,他引:1  
目的 探讨影响快速二期大动脉转位术早期死亡的危险因素.方法 回顾性研究2002年9月至2007年9月期间,21例快速二期大动脉转位术病婴临床资料.采用Logistic多元线形回归分析模型对病婴的人口统计学资料,术前诊断资料,左心功能锻炼期资料,以及二期大动脉转位术术中和术后数据进行统计分析,探讨影响快速二期大动脉转位术的危险因素.结果 该手术初期死亡率较高,呈逐年下降趋势.与左心功能锻炼术后死亡相关的为B-T分流自径(P=0.003);与快速二期大动脉转位术后死亡相关的为女性(P=0.006)和术前pLV/RV(P<0.001).结论 快速二期大动脉转位术是目前治疗错过最佳手术时机的室隔完整型D-TGA病婴的最佳手术方式;使已退化的左心功能得到足够锻炼,是决定二期大动脉转位术成功的关键所在.
Abstract:
Objective To investigate the risk factors associated with early mortality of the rapid two-stage arerial switch operation, which has a significantly higher overall mortality than that of ASO procedure for D-TGA with a intact ventricular septun. Methods The data we reviewed involving patients who underwent rapid two-stage switch operations from September,2002 to September, 2007 in our center, 13 patients were male and 8 were female, their age at operation ranged from 29 to 250 days afer birth, and the body weight was 3.5 to 7 kg. Chi-squared test and multivariant logistic regression methods were used for the analysis of demographic data, pre-diagnosis information, operation data, interval data combined with the operation time,left ventricle training condition, and the early post-operative outcomes. Results The operative mortality was high at initial stage, and then decreased gradually. The logistic multivariant regression analysis indicated that the mortality of left ventricular training operation was associated with the diameters of BT shunt ( P =0.003 ); the mortality of two-stage switch was associated with feminie ( P = 0.006 ) and pre-operative p. LV/RV ( P < 0.001 ). Conclusion Patients with transposition of the great arteries and intact ventricular septum who missed the optimal time for switch operation should receive rapid two-stage switch operations, which provide an opportunity for the correction of the deformity. The key factor associated with the success for operation was good in heart function after left ventricular training.  相似文献   

5.
169例动脉调转手术治疗大动脉转位的早、中期结果   总被引:3,自引:0,他引:3  
目的 探讨大动脉调转手术(ASO)治疗完全性大动脉转位(TGA)的早、中期结果,分析其随访死亡、术后主动脉瓣反流及肺动脉狭窄的危险因素.方法 2004年1月至2007年12月,169例行动脉调转术病儿入选,其中男129例,女40例,平均年龄(11.7±26.3)个月.病儿分两组:Ⅰ组为室间隔完整组(56例),Ⅱ组为室间隔缺损组(113例).所有术后生存病儿均进行超声随访,平均随访时间(27.7±14.6)个月.危险因素采用Logistic回归模型分析.结果 全组住院死亡19例(11.24%),两组间差异无统计学意义.随着整体治疗水平的提高,住院病死率由2004年的16.67%下降到2007年的3.92%.1、3及5年生存率分别为94.00%、91.33%及91.33%,两组间差异无统计学意义.Logistic回归分析发现,ASO术后随访死亡的危险因素为手术年龄大于6个月;术后主动脉瓣反流的危险因素为合并室间隔缺损、年龄大于6个月、术后新主动脉瓣Z值>1;术后肺动脉狭窄的危险因素为手术年龄小于1个月和肺动脉采用补片成形.结论 ASO手术具有良好的早、中期结果,是治疗完全性大动脉转位的理想术式.TGA病儿应该尽早手术治疗,手术年龄大于6个月是随访死亡及主动脉瓣反流的重要危险因素;新主动脉根部与主动脉远端不匹配是术后主动脉瓣反流的危险因素;病儿的生长发育与肺动脉成形材料无生长特性的矛盾是导致术后肺动脉狭窄的危险因素.  相似文献   

6.
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.  相似文献   

7.
快速二期动脉转位术纠治新生儿完全型大动脉转位   总被引:9,自引:2,他引:9  
目的总结快速二期动脉转位术的临床应用效果.方法 2002年9月至2003年5月,5例完全型大动脉转位患者行快速二期动脉转位术.手术平均年龄83.0±72.2 天,平均体重4.7±0.9 kg.由于求诊时已经超过最佳手术年龄,左心室退化,不能承受体循环压力,则先行肺动脉环缩和体肺动脉分流术,术后6~9天行第二期动脉转位术.结果一期手术中,1例术后32小时发生室上性心动过速,少尿,经腹膜透析和药物处理无效死亡;其余4例分别在术后6~9天行二期动脉转位术,无死亡.术后随访2~10个月,生长发育良好,超声心动图检查显示心内无残余分流,主动脉和肺动脉干吻合口通畅,左心室射血分数(EF)0.68~0.77,短轴缩短率(FS)0.24~0.37,1例主动脉瓣轻度反流.结论对失去最佳手术时间的新生儿完全型大动脉转位,行快速二期动脉转位术是最佳的选择.  相似文献   

8.
完全性大动脉转位的麻醉处理   总被引:1,自引:0,他引:1  
完全性大动脉转位(TGA)是比较常见的紫绀型先天性心脏病(简称先心病)之一,约占先心病的7%~9%,自然预后极差。大动脉转换术又叫大动脉调转术(switch术),已广泛应用于完全性大血管转位的纠治,取得较好的手术效果[1,2]。现将我院自1998年5月至2004年11月共8例患儿完全性大动脉转位  相似文献   

9.
目的 探讨双调转手术和传统修复术治疗矫正型大动脉转位合并心内畸形的效果.方法 2002年4月至2006年12月,19例矫正型大动脉转位合并心内畸形患者接受手术治疗,男性14例,女性5例;年龄2~22岁,平均8.6岁.合并的心内畸形包括:室间隔缺损18例,右心室双出口1例,肺动脉狭窄17例,房间隔缺损4例,肺动脉高压2例.手术方式包括双调转手术解剖矫正修复15例,传统修复术治疗心内畸形4例.结果 双调转术后死亡1例,发生严重低心排血量综合征2例,一过性房室传导阻滞1例,反复胸腔积液2例.传统心内修复术后无死亡病例,发生严重低心排血量综合征1例.双调转手术存活者随访6个月~4年,均为窦性心律,心功能NYHA分级Ⅰ~Ⅱ级,射血分数51%~68%.传统心内修复术存活者随访1年,3例心功能达Ⅰ~Ⅱ级,射血分数52%~61%;1例心功能Ⅲ级,射血分数40%.结论 双调转手术解剖修复矫正型大动脉转位合并心内畸形早中期效果良好,严格选择手术适应证和手术时机是提高手术效果的关键.对于右心室功能较好,无三尖瓣畸形的患者,如果存在影响双调转效果的因素,仍应选择传统心内修复手术.  相似文献   

10.
目的 研究不同类型完伞性大动脉转位(TGA)的个体化外科治疗策略及其效果.方法 1998年3月至2009年10月,共收治各类TGA患者127例(158例次),男性97例,女性30例.年龄生后4 h~17岁,平均(25±37)个月,其中<3个月56例66例次;体质量2.7~47.5 kg,平均(8±8)kg.初期手术行Glenn手术14例(其中3例行双侧Glenn手术),主-肺动脉分流术14例,肺动脉环缩术8例,房间隔缺损扩大+肺动脉环缩+主-肺动脉分流术15例.终期手术包括Seaning手术5例,一期Switch手术32例,二期Switch手术11例,Switch手术+室间隔缺损修补术20例,Switch手术+室间隔缺损镶嵌手术1例,Nikaidoh手术3例,Rastelli手术13例,Fontan手术18例,心内隧道等其他手术4例.结果 20例患者接受初期手术后现正在等待或已放弃二期手术,21例患者接受2期手术,5例接受3次及以上手术.66例次患者术后延迟关胸.采用腹膜透析9例,呼吸机使用时间2 h~16 d.全组早期死亡12例(病死率9.4%),死因包括术后低心排出最5例,肺动脉高压危象2例,术中出血2例,冠状动脉畸形1例,感染合并自发性肝破裂1例,肾功能衰竭1例.109例患者术后随访1个月~12年,6例失访,远期2例死亡.随访患者中,10例有不同程度的并发症,3例已再次手术,随访效果好.余存活病例,心功能正常,生长发育良好.结论 根据TGA患者解剖条件,采用个体化治疗策略,制定不同的手术方案,可以明显提高患者的手术成功率和远期生存率.  相似文献   

11.
Objective: To analyse the long-term patency of coronary arteries after neonatal arterial switch operation (ASO). Methods: A retrospective study of the operative reports, follow-up and postoperative catheterisation data of 119 patients, who underwent the great arteries (TGA) repair since 1991, has been carried out. Patient population: Among the 133 survivors of the 137 ASOs performed between 1991 and 2007, 119 patients have been studied by routine control cardiac catheterisation and form the study population. Median time between repair and the coronary angiography was 2.9 ± 1.9 years. A comparison between the eight patients (6.7% out of the entire study population), known to have postoperative coronary obstructions (group I) and the rest of the cohort with angiographic normal coronary vessels (group II) was performed by univariate analysis of variance and logistic regression models. One patient had surgical plasty of the left coronary main stem with subsequent percutaneous angioplasty, three patients had primary coronary stent implantation and four patients had no further intervention at all. In group I, all but one patient denied symptoms of chest pain and echocardiography failed to show any difference between the two groups in terms of left ventricular systolic function (ejection fraction group I 61 ± 2% vs 62 ± 6% of group II, p = 1.0). Results: The association of coronary obstruction with complex native coronary anatomy (Yacoub type B to E) was evident at both univariate (62% of group I vs 22% of group II, p = 0.04) and logistic regression (p = 0.007, odds ratio (OR) 8.1) models. The type of coronary reimplantation (i.e., coronary buttons on punch vs trap-door techniques) was similar between the two groups (punch reimplantation in 25% of patients of group I vs 31% of group II, p = 0.1) as was the relative position of the great vessels (aorta anterior in 100% of patients of group I vs 96% of group II; univariate, p = 0.1). Conclusions: The late outcome in terms of survival and functional status after ASO is excellent. Nevertheless, the risk of a clinically silent late coronary artery obstruction of the reimplanted coronary arteries warrants a prolonged follow-up protocol involving invasive angiographic assessment.  相似文献   

12.
Xu ZW  Wang SM  Zhang HB  Zheng JH  Su ZK  Ding WX 《中华外科杂志》2005,43(22):1441-1443
目的评估一期纠治完全性大血管错位(TGA)和右心室双出口肺动脉瓣下室间隔缺损(Taussig-B ing)伴主动脉弓病变的手术疗效。方法2001年1月—2004年6月对8例伴主动脉弓病变的TGA(3例)和Taussig-B ing(5例)行一期手术治疗。3例TGA中,室间隔完整型1例,伴室间隔缺损2例;主动脉弓病变为7例主动脉缩窄、1例主动脉弓中断。手术年龄1例为8个月,7例为5 d~3个月,平均40 d,体重3.5~6.3 kg,平均(4.3±0.5)kg。均采用胸骨正中切口。手术先在深低温、停循环下矫治主动脉弓病变,然后在深低温、低流量下行大动脉转换术(Sw itch术)。体外循环转流时间107~159 m in,平均(126±23)m in,主动脉阻断时间63~118 m in,平均(92±16)m in,停循环14~45 m in,平均(30±12)m in。结果手术死亡1例,为8个月Taussig-B ing伴主动脉弓发育不良、冠状动脉畸形患儿,术后因低心排血综合征、Ⅲ度房室传导阻滞、肺高压危象死亡;1例3月龄患儿术后5 d喂奶时窒息死亡。6例随访5个月~2年,生长发育良好,1例Taussig-B ing主动脉弓中断出现吻合口狭窄,压差60 mm Hg;2例出现主动脉瓣轻微返流,1例肺动脉瓣轻度返流。结论一期纠治TGA和Taussig-B ing伴主动脉弓病变能取得较好手术效果,手术死亡原因为肺动脉高压和冠状动脉畸形。  相似文献   

13.
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.  相似文献   

14.
Rastelli手术治疗大动脉转位伴室间隔缺损   总被引:4,自引:0,他引:4  
目的介绍Rastelli手术治疗大动脉错位伴室间隔缺损的经验.方法全组49例中男29例,女20例.平均年龄5.6岁;平均体重17.2kg.完全性大动脉转位31例,纠正性大动脉转位18例;伴肺动脉狭窄45例,伴肺动脉高压4例.均在低温体外循环下行Rastelli手术.二期根治5例.体外循环灌注(178.5±52.5)min;主动脉阻断(109.2±38.3) min.结果手术早期死亡6例,死亡率12.2%.死因为肺动脉高压危象、肾衰、心律紊乱和严重低心输出量综合征.术后并发症有心律紊乱、肺动脉高压危象、蛛网膜下腔出血、脑功能紊乱、肾衰及多脏器功能衰竭、心包或胸腔积液、感染等.CICU平均监护7.3 d.随访中因同种带瓣大动脉(VHC)感染死亡1例.结论完全性大动脉转位手术中,右室流出道直切口有利于心内隧道修补室间隔缺损;纠正性大动脉转位手术中,解剖右室径路显露缺损较好且易避开传导系统,但不利于术后心功能恢复.而解剖左室径路修补室间隔缺损的房室传导阻滞发生率高;大于4岁者手术宜选择大号VHC可减少再次手术几率;对无长段左室流出道狭窄的完全性大动脉转位病婴,可在动脉换位术基础上行肺动脉瓣叶交界切开或Konno术以解除左室流出道梗阻.为防止术后功能性二尖瓣反流,对伴肺动脉狭窄的纠正性大动脉转位病儿,提倡心房-大动脉双换位手术.  相似文献   

15.
Objectives: The aims of this report were to study the early and late outcome in terms of mortality, freedom from reoperation, predictors for late pulmonary stenosis (PAS) and insufficiency of the neo-aortic valve (AVI) in patients with transposition of the great arteries (TGA) undergoing arterial switch operation (ASO). Materials and methods: Between January 1990 and December 2001, 134 patients with TGA underwent ASO. The patients were divided in Group I (n=88)-TGA with intact ventricular septum and Group II (n=46)-TGA with ventricular septal defect (VSD). The pulmonary artery was reconstructed employing the direct anastomosis technique (PT-I) in 21 (15.7%) patients, the double-patch technique (PT-II) in 41 (30.6%), single pantaloon patch (partial circumference) (PT-III) in 46 (34%) and single pantaloon patch (total circumference) (PT-IV) in 35 (26%) patients. The mean follow-up was 3.4±1.3 years. Results: The hospital mortality was 17 (12.7%) patients. The mortality in Group I was significantly lower than Group II (P=0.002). The overall actuarial survival at 1, 3 and 5 years follow-up resulted to be 98, 93, and 91.5%, resulting to be significantly higher in Group I (P=0.032). The multivariate analysis revealed the complex TGA (P=0.007), VSD (P=0.032), coronary anomalies (P=0.004), aortic coarctation or hypoplastic aortic arch (P=0.021), left ventricular outflow tract obstruction (LVOTO) or moderate PAS (P=0.041) as strong predictors for poor free-reoperation cumulative survival. A strong inverse correlation was found between the mean trans-pulmonary gradient at follow-up and the age at the operation (r=−0.41, P<0.0001). The univariate analysis revealed the PT-I technique (P=0.002), prior moderate PAS (P=0.0001), and age <1 month (P=0.018) as strong predictors for moderate-to-severe PAS. The neo-AVI incidence was significantly higher in Group II (P=0.011). Predictors for neo-AVI were male sex (P=0.003), preoperative neo-AV Z-score >1 (P<0.001), prior or concomitant operation for aortic coarctation or hypoplastic aortic arch (P=0.001), LV retraining (P=0.003). Conclusion: ASO remains the procedure of choice for the treatment of various forms of TGA with acceptable early and later outcome in terms of overall survival and free reoperation. Strong predictors for poor overall free-reoperation survival are complex TGA, VSD, coronary anomalies, aortic coarctation and LVOTO or moderate PAS. The pulmonary artery reconstruction using a single ‘pantaloon patch’ seems to offer less residual stenosis. Patients with a VSD and a significant mismatch between the neo-aortic root and distal aorta are at a higher risk for developing postoperative neo-AVI.  相似文献   

16.
The arterial switch operation has evolved into the treatment of choice for most forms of transposition of the great arteries (TGA). Recently reported operative mortality of the procedure has fallen to the range of 1.1%–6.0%, even for complex forms of TGA. Despite advancement in the technical aspects of the procedure, certain anatomical variations of the coronary arteries, such as a single coronary orifice and/or intramural coronary artery, are still considered surgical risks in many centers. Optimizing the surgical technique for relocating these challenging variations of the coronary anatomy is key to improving the surgical outcomes for the procedure. In this review, the surgical modifications of the arterial switch operation for TGA associated with complex patterns of the coronary arteries are examined. This review was submitted at the invitation of the editorial committee.  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号