大动脉转换术治疗完全性大动脉错位27例

目的回顾性总结我院采用大动脉转换术（ASO）治疗完全性大动脉错位的疗效。方法2004年4月至2008年12月．应用大动脉转换术治疗完全性大动脉错位（D—TGA）27例，其中〈2周11例，〈4周8例，〈6个月4例，〈1岁3例，〉1岁1例。室间隔完整型大动脉错位（D—TGA／IVS）19例，其中快速二期4例。大动脉错位合并室间隔缺损（D—TGA／VSD）8例。所有患者均在经鼻气管插管全麻深低温低流量体外循环下行ASO。结果全组死亡5例，病死率18．5％。其中TGA／IVS15例，死亡2例，1例为肺出血，1例为重度黄疸、肝功能衰竭。TGA／IVS快速二期4例，无死亡。TGA／VSD 8例，死亡3例，2例合并冠状动脉畸形，1例死于出血。22例随访3～56个月，心功能均正常，残余主动脉轻度梗阻1例，肺动脉轻度梗阻3例。结论大动脉转换术治疗TGA效果良好。适当的手术时机和冠状动脉的完美转移是手术成功的关键。

Arterial switch operation for complete transposition of great arteries in 27 cases PENG

Objective To review the effect of arterial switch operation （ASO） for complete transposition of great arteries in our hospital from April 2004 to December 2008. Methods Twerty - seven cases of complete transposition of great arteries （TGA） were repaired by the ASO between April 2004 and December 2008. There were 19 patients with trans- position of great arteries with intact ventricular septal （TGA/IVS）, age from 6 to 120 [ average （21.7± 13.6）] days, weight from 2.8 to 5.4 （ 3.6±0.5 ） kg. And there were 8 patients of transposition of great arteries with ventricular septald defect （ TGA/VSD）, age from 9 to 72 [ average （41.0±26.5 ） ] days, weight from 3.1 to 5.3 average （ 3.8±0.4） kg, except one case of 4 years. All cases underwent ASO under uhrafiltration and modified uhrafiltration, deep hypothermic low flow CPB. Results There were 5 deaths （ 2 from TGA/IVS group and 3 from TGA/VSD group） and no death in rapid two - stage ASO. The hospital mortality was 18.5%. 22 survivors were followed - up. One patient had residual ascending aorta obstruction and 3 patients had mild pulmonary obstruction. Conclusions Arterial switch operation can be performed in congenital transposition of great artery. The key is operative opportunity and perfect transfer of the coronary arteries.