快速二期大动脉转位手术前等待期的临床观察

目的探讨超龄完全性大动脉转位(D-TGA)病婴经历了肺动脉环缩(PAB)和体肺分流(BTS)的左心室准备术后,如何安全度过快速二期大动脉转位术(ASO)前的等待期。方法2002年9月至2006年8月,21例D-TGA病婴实施了快速二期ASO前的准备(PAB和BTS)。结果等待期中,2例行BTS再通,2例行PAB松解,1例行再次PAB;12例并发低心排出量综合征,7例并发室上性心动过速,5例行心肺复苏,死亡率14.3%(3/21例)。18例度过准备期接受二期手术,等待期9(1～150)d,平均(22.4±36.7)d,死亡率16.7%(3/18例)。结论快速二期ASO前的等待期中,平衡左、右心室的压力和容量负荷,及时逆转低心排出量综合征,判断左心室准备完成、适时行二期ASO,是安全渡过准备期的关键。

Course in the intensive care unit before rapid two-stage arterial switch operation for transposition of the great arteries

Objective To determine outcomes of preparatory operation for patients with transposition of the great arteries with low left ventricular pressure.Methods A retrospective review of a consecutive series of infants older than 3 weeks of age who underwent pulmonary artery banding with Blalock-Taussig shunt at a single institution.Results From September 2002 to August 2006,21 infants underwent preparatory operation before rapid,two-stage arterial switch operation with 3 deaths.Nine days after first operation,asuccess- ful arterial switch operation was performed in 18 patients with 3 deaths.After the preparatory procedure,the initial postoperative period was frequently characterized by a low cardiac output syndrome of variable length and severity.Conclusion Low cardiac output syndrome should be anticipated following the preparatory procedure.The low cardiac output syndrome is most likely due to a combination of acute right ventricular volume overload from the shunt and acute left ventricular dysfunction from the pulmonary artery band.