自体主动脉瓣移植纠治完全性大血管错位伴肺动脉瓣狭窄

目的探讨解剖纠治完全性大血管错位（TGA）伴肺动脉瓣狭窄的手术方法。方法1例8月龄、体重6．5kg的TGA伴肺动脉瓣狭窄男病婴，术中将原主动脉瓣移植至肺动脉瓣处形成新的主动脉；再行Switch术，同种带瓣管道连接右心室与肺动脉。另1例10月龄、体重9．8kg的该病男病婴，术中将整个主动脉瓣取下，保留左、右冠状动脉，向后移植，后半部分直接与原肺动脉瓣环连续缝合，前半部分与室间隔缺损之间采用dacron补片连续缝合关闭；肺动脉与右心室切口直接连接。结果2例手术均取得成功。出院时超声检查各吻合口通畅，无残余分流．无主动脉瓣反流。术后随访12个月和6个月，生长发育良好，心胸比率0．75。超声示左心功能良好，前例示主动脉瓣轻度反流．后例左、右心室流出道无残余梗阻．结论采用自体主动脉瓣移植纠治完全性大血管错位伴肺动脉瓣和瓣下狭窄，从解剖上得到彻底纠治．效果良好。由于病例少，随访时间短．还需进一步观察。

Complete transposition of the great arteries with pulmonary stenosis repaired by aortic translocation

Objective To report two cases of the aortic translocation operation for complete transposition of the great arteries (TGA) with pulmonary valve stenosis (PS). Methods Patient 1, a 8-month-old boy (6.5 kg), with TGA/PS, underwent aortic translocation, the aortic valve was harvested and transfered to pulmonary root, then arterial switch procedure was performed. The aortic homograft was connected between pulmonary and right ventricle. Patient 2, a 10-month-old boy (9.8 kg), with TGA/PS and subpulmonary stenosis, underwent aortic translocation procedure. Results The postoperative course was very smooth and postoperative echocardiogram revealed no stenosis, no residual shunt and regurgitation. During follow-up of 6 months to 1 year, one patient had mild aortic regurgitation. 2 had no left and right ventricular outflow tract obstruction. Conclusion Aortic translocation, a technique of anatomic correction without extracardiac conduit, provides an additional type of arterial switch operation for TGA/PS. It can achieve good cardiac performance. However, further studies are required.