完全性大动脉错位动脉转位术后新主肺动脉发育的随访

目的 报道应用动脉转位术（ASO）治疗完全性大动脉错位（TGA）术后超声心动图的随访结果，评价TGA术后主、肺动脉的发育情况。方法 以2001年3月至2007年3月于复旦大学附属儿科医院心血管中心实施ASO治疗TGA术后存活患儿作为研究对象，于2008年8～9月进行随访，行超声心动图检查，测定新主动脉根部内径、新主动脉瓣环内径、新肺动脉内径和新肺动脉瓣环内径，获取的数据与正常参考值做比较。 结果 研究期间ASO治疗TGA患儿共72例，术中死亡6/72例（8.3％），存活率为91.7%。失访10/66例，有效数据56例，其中室间隔完整的完全性TGA（TGA/IVS）32例，完全性TGA合并室间隔缺损（TGA/VSD）24例。随访距手术18～168(86.46±23.51)个月。新主动脉根部内径为(16.97±2.71) mm(t=6.936，P<0.001)，12/56例(21.4%)>正常参考值90%CI的上限, 44/56例(78.6%)在正常参考值90%CI内，平均Z值为1.10±0.70。新主动脉瓣环内径为(16.27±2.38) mm(t=4.52，P<0.001)，56例均在正常参考值90%CI内，平均Z值为0.66±0.65。新肺动脉内径为(14.29±1.92) mm(t=-3.2，P=0.005)， 40/56例(71.4%)在正常参考值90%CI内，16/56例(28.6%)<正常参考值90%CI的下限，平均Z值为-0.95±1.33。 新肺动脉瓣环内径为(14.00±1.92) mm(t=0.132，P=0.897)， 42/56例(75.0%)在正常参考值90%CI内，14/56例(25.0%)<正常参考值90%CI的下限，平均Z值为0.05±1.85。16/56例(28.6%)存有主动脉瓣轻度反流，均为TGA/VSD病例，平均随访(46.0±22.2)个月；40/56例（71.4％）未见主动脉瓣反流，平均随访(46.8±25.3)个月，两组随访时间差异无统计学意义（P=0.899）。随访中未见主动脉狭窄病例。肺动脉瓣上狭窄7/56例(12.5%)，2/56例(3.6%)为轻度狭窄，5/56例(8.9%)为极轻度狭窄。结论 目前在复旦大学附属儿科医院心血管中心开展ASO治疗TGA术后新主动脉根部和瓣环内径均有所扩张，新肺动脉根部内径有所缩减，但其瓣环发育良好。主动脉瓣反流常见于TGA/VSD病例，但其反流程度较轻。肺动脉瓣上狭窄是TGA术后常见的并发症，但大多数病例狭窄程度极轻。

Mid-term follow-up outcome of the neo-aorta and neo-pulmonary artery in patients after arterial switch operation for transposition of the great arteries

Objective To evaluate the development of the great arteries after arterial switch operation (ASO) for transposition of the great arteries (TGA).Methods From March 2001 to March 2007, we carried out ASO for 72 cases with TGA or Taussig Bing anormaly in the cardiovascular center of Children′s Hospital of Fudan University. Patients were follow up by using echocardiography after ASO. The size of the great arteries in TGA patients after ASO was compared with normals.Results 72 cases dignosed as TGA were undergoing ASO, 6 cases were death during the ASO.10 cases were loss of follow up. 32 cases of TGA with intact ventricular septum (TGA/IVS) and 24 cases of TGA with ventricular septum defect (TGA/VSD) (n=24) were evaluated at (86.46±23.51)m (from 18 to 168 months) after ASO by using echocardiography.The diameter of neo aortic root was from 13.8 mm to 26.4 mm(16.97±2.71) and the mean Z score of it was 1.10±0.70(t=6.936，P<0.001). There were 12 cases (21.4%) with diameter of neo aortic root beyond 90% confidence interval for controls and 44 cases (78.6%) within 90% confidence interval for controls. The diameter of neo aortic valve annulus was from 12.9 mm to 23.3 mm(16.27±2.38) mm and the mean Z score of diameter of it was 0.66±0.65(t=4.52，P<0.001). All of these 56 cases with diameter of neo aortic valve annulus were within 90% confidence interval for controls. The diameter of pulmonary artery was from 10.6 mm to 17.0 mm(14.29±1.92) mm and the mean Z score of it was -0.95±1.33 (t=-3.2，P=0.005).There were 16 cases (28.6%) with diameter of pulmonary artery below 90% confidence interval for controls and 40 cases (71.4%) within 90% confidence interval for controls. The diameter of pulmonary valve annulus was from 10.5 mm to 16.0 mm(14.00±1.92) mm and the mean Z score of it was 0.05±1.85(t=0.132，P=0.897). There were 14 cases (25.0%) with diameter of pulmonary valve annulus below 90% confidence interval for controls and 42 cases (75.0%) within 90% confidence interval for controls. Mild aortic regurgitation was observed in 16 cases (28.6%) and there was no relation with the interval time of follow up(P=0.899). Neo aortic stenosis was not found. Trivial mild and mild supravalvular pulmonary stenosis occured in 5 cases (8.9%) and 2 cases (3.6%) respectively.Conclusions Mid term follow up outcome after ASO for TGA showed the dilation of neo aortic root and valve annulus and the reduction of pulmonary artery while satisfactory size of pulmonary valve annulus. Mild aortic regurgitation and supravalvular pulmonary stenosis were frequent complications though with low grade.