半旋转动脉干调转术治疗完全性大动脉转位合并室间隔缺损和肺动脉狭窄

目的 报道半旋转动脉干调转术治疗完全大动脉转位(TGA)合并室间隔缺损(VSD)和肺动脉狭窄(PS)的近期疗效.方法 2例病儿男、女各1例,分别为16岁和19个月.均为TGA/VSD/PS.采用半旋转动脉干调转术治疗.结果 2例病儿均生存.女病儿术后发生低心排出量综合征和毛细血管渗漏综合征,治疗后痊愈.男病儿术后恢复良好.术后分别随访10、9个月,心功能Ⅰ级.结论 半旋转动脉干调转术可有效治疗TGA合并VSD和PS.长期效果仍需观察.

Half-turned truncal switch operation for complete transposition of the great arteries with ventricular septal defect and pulmonary stenosis and double outlet of right ventricle with pulmonary stenosis

Objective To report two cases of half-turned truncal switch operation for anatomic repair of complete transposition of the great arteries (TGA) with ventricular septal defect (VSD) and pulmonary stenosis (PS) and double outlet of right ventricle (DORV) with TGA and PS.Methods Two patients underwent half-turned truncal switch operation in our department,one was TGA/VSD/PS (SDD) and the other was DORV/TGA/PS.The ascending aorta and main pulmonary artery were transected and both right and left coronary arteries were resected with a U-shaped buttons.The truncal block with both semilunar valves was separated from the ventricular outlet tract.The resected truncal block was half turned and anastomosed to the ventricular outlet tract,bringing the aortic root over the left ventricular outlet and the pulmonary root over the right ventricular outlet.Both coronary buttons were re-anastomosed to the aortic wall.The VSD was closed with a patch.The posterior pulmonary wall was anastomosed to the posterior wall of right ventricular outlet tract and right ventricular outlet was reconstructed with autopericardiac patch.Results Two patients survived.One patient had postoperative low cardiac output syndrome and capillary leak syndrome,was discharged after 25 days.The Second patient recovered well.Follow-up for 9,10 months,two patients were in NYHA Ⅰ grade.Conclusion Half-turned truncal switch operation is an option for TGA/VSD/PS or DORV/PS.Reoperation for the problems of intracardiac tunnel and extracardiac conduit may be avoided.