快速二期动脉调转术应用的体会

目的:报告采用快速二期动脉调转术(ASO),治疗完全性大动脉转位(TGA)合并完整室间隔畸形的初步体会。方法:2006年1月至2007年1月,采用快速两期ASO治疗4例室间隔完整型TGA患儿。年龄1.2个月~20个月;体重4.0~9.5 kg。一期手术主要采用肺动脉环缩及Blalock-Taussig分流术进行左心室功能训练。至二期ASO前,左心室心肌质量、舒张末径和容积、室间隔和左心室后壁厚度分别较左心室训练前增长了102%~120%、30.3%~37.5%、79.1%~143.6%、5.5%~26.7%和20%~50%。室间隔位置由偏向左心室侧转为偏向右心室侧或居中。二期手术间隔5~19 d。结果:术后早期均无心肌缺血及明显低心排出量综合征表现。存活3例,另1例在二期手术体外循环过程中及术后早期无尿,术后28h死于肾功能衰竭。结论:对于年龄错过新生儿期室间隔完整型TGA患儿,在根治手术前采用肺动脉环缩先对左心室进行功能训练,为一种可选择的、有效的方法。

Rapid two-stage arterial switch operation for transposition of the great arteries with intact ventricular septum

Objective：To introduce the preliminary understanding of using rapid two-stage arterial switch operation for transposition of the great arteries with intact ventricular septum. Method： Between January 2006 and January 2007, rapid two-stage arterial switch operation was performed for transposition of the great arteries with intact ventricular septum in 4 patients. Their ages ranged from 1.2-20 months ; Weight ranged from 4.0-9.5 kg. Pulmonary artery banding was done as the first stage for left ventricle retraining. Before the second stage, left ventricular mass, end diastolic volume and diameter of left ventricle, thickness of ventricular septum and left ventricula/posterior wall increased 102 % - 120 %, 30.3 % -37.5 %, 79.1% - 143 %, 5.5 % -26.7 % and 20 % -50 %. The duration between the two stages was 5-19 days. Result：There was no clinical myocardial ischemia and low output syndrome during the early postoperative period in all patients. 3 caese were survival. Another was early death after the second stage due to renal failure, there was no urine during the whole period of operation. Conclusion： Rapid two-stage arterial switch operation is the one choice of effective consideration for the treatment of transposition of the great arteries with intact ventricular septum.