107例大动脉转换术的冠状动脉解剖类型和治疗结果

目的总结分析近年来107例大动脉转换术的冠状动脉解剖分类和手术结果，以进一步提高大动脉转换术的手术成功率。方法2000年1月至2004年9月，采用大动脉转换术纠治完全性大血管错位室隔完整型（TGA／IVS）44例，完全性大血管错位伴室间隔缺损（TGA/VSD）38例，右室双出口伴肺动脉瓣下室间隔缺损、肺动脉高压（Taussig-Bing）25例，其中冠状动脉畸形28例，占全组28％。结果大动脉转换术107例中死亡17例，总病死率15．88％。其中TGA/IVS组死亡4例，病死率9．02％；TGA／VSD组死亡8例，病死率21．05％；Taussig-Bing组死亡5例，病死率20．00％。90例术后随访6个月～4年，VSD残余漏3例，2例分别在术后1个月和2个月自愈，1例同时伴右室流出道梗阻，术后3个月再次手术治愈。肺动脉瓣上狭窄2例尚在随访中。其余病儿活动良好，无任何心肌缺血表现。结论冠状动脉畸形的变异很多，分型比较困难，Leiden方法简单，易掌握。Taussig-Bing的冠状动脉畸形发生率较高，TGA／VSD的冠状动脉畸形达40％左右，进行Switch手术时应注意。

Classification of coronary artery anatomy and results of 107 arteries switch procedures

Objective To review the anatomical classification of coronary artery and results of 107 arteries switch operation. Methods 107 patients were repaired by arterial switch operation from January 2000 to September 2004. There were 44 patients with transposition of great arteries and intact ventricular septum (D-TGA/IVS), 38 patients with transposition of great arteries and ventricular septal defect (D-TGA/VSD) and 25 patients with double outlet of right ventricle with subpulmonary ventricular septum defect (TaussigBing). There were 28 patients with abnormal coronary arteries (28%). Results There were 4(9.02%) deaths in TGA/IVS group, 8 (21.05%) deaths in TGA/VSD group and 5(20.00%) deaths in Taussig-Ring group.The total mortality was 15.88%. All patients were followed from 6 months to 4 years., Three patients had residual VSD, it closed spontaneously after 1 - 2 months postoperatively. One patient had residual VSD and subpulmonary stenosis, was reoperated after 3 months.Two patients had supra pulmonary valve stenosis , they were followed up. All others had good heart function and no myocardium ischemia symptoms. Conclusion Classification of abnormal coronary arteries is difficult because there are variations. The Leiden classification was simpler.Incidence of abnormal coronary arteries is higher in Taussig-Bine group and TGA/VSD group, so due attention should be paid during switch operation.