大动脉转位术治疗合并室间隔缺损的大动脉错位

Surgical Outcome of the Arterial Switch Operation for Transposition of the Great Arteries Associated with Ventricular Septal Defect

目的 报道采用动脉转位手术(Switch手术)治疗合并室间隔缺损的大动脉错位(transposition of great arteries associated with ventriculai septal defect,TGA／VSD),探讨围手术期治疗要点。方法2000年11月至2003 年7月,8例合并室间隔缺损的大动脉错位接受Switch手术。6例完全性大动脉错位合并室间隔缺损中5例为 大型室间隔缺损伴肺动脉高压,1例为小型室间隔缺损,急诊行球囊房间隔造口术以缓解缺氧。另2例为右心 室双出口伴肺动脉瓣下室间隔缺损伴肺动脉高压。其中6例术前经心导管和造影检查。所有病例均在深低温 低流量体外循环下行Switch手术。结果 全组体外循环时间132-225 min[(189±52)min],主动脉阻断时间 68-162 min[(115±41)min]。术后常规施行改良超滤,机械辅助通气,应用血管活性药物。1例进行腹膜透 析,6例应用吸入一氧化氮治疗。全组死亡1例(12.5％)。机械通气时间3-7 d[(4.5±2_8)d]。并发症包括切 口渗血1例,肺不张2例,切口感染1例。术后随访所有病例发绀、气急、多汗症状消失,生长发育明显改善,活 动耐量增加。胸片肺血正常,心影明显缩小。超声心动图检查显示,1例残余室间隔缺损,轻度主动脉和肺动脉 瓣上狭窄各1例。结论 大动脉转位术是治疗TGA／VSD的首选方法,及时诊断治疗和恰当的围手?

Purpose To report the surgical outcome of the arterial switch operation (ASO) for transposition of the great arteries associated with ventricular septal defect.Methods From November 2000 to July 2003, ASO were performed in 6 cases with transposition of the great arteries associated with ventricular septal defect and 2 cases with Taussig-Bing anomaly. Six cases underwent cardiac catheterization and angiography and demonstrated severe pulmonary hypertension. Results There was 1 death (12.5%).Cardiopulmonary bypass time was 132-225 min( [189±52] min) and aortic cross clamp time was 68-162 min([115±41] min). Inhalation of nitric oxide was applied in 6 patients among them two patients were given nitric oxide inhalation early in the operating theatre during bypass. Follow-up demonstrated that one patient had a small residual VSD and there were mild supravalvar-aortic and supravalvar-pulmonary stenosis in one patient respectively. Conclusions Arterial switch operation is of the first choice for transposition of the great arteries associated with ventricular septal defect. The surgical outcome has been satisfactory.