动脉转位术后左心室功能和大动脉发育的中期随访观察

Mid-term follow-up outcome of left ventricle function and size of the great arteries in patients after arterial switch operation.

目的观察动脉转位术(ASO)治疗复杂先天性心脏病术后早中期超声心动图的随访结果,评价该手术后左心室的功能和大动脉的发育.方法 2000年10月至2004年3月,复旦大学儿科医院对实施ASO后4～37(19.6±11.1)个月的16例患儿进行超声心动图检查,其中室间隔完整的完全性大动脉转位(TGA/IVS)8例,完全性大动脉转位合并室间隔缺损(TGA/VSD)6例,右室双出口合并肺动脉瓣下室间隔缺损(Taussig-Bing畸形)2例.将获取的资料与正常参考值作比较.结果左室短轴缩短率(LVSF)为(38.10±5.90)%,其中14例(87.5%)在正常范围,2例(12.5%)大于正常范围;左室射血分数(LVEF)为(69.16±7.01)%,均在正常范围.主动脉根部直径平均较正常值扩大(5.5±3.2)mm,其中14例(87.5%)大于正常值95%可信区间的上限;瓣环直径较正常值平均扩大(3.6±3.3)mm,其中10例(62.5%)大于正常值95%可信区间的上限.主肺动脉直径较正常值平均小(1.3±1.5)mm,其中9例(56.25%)在正常值95%可信区间内;瓣环直径较正常值平均小(1.1±1.7)mm,其中10例(62.5%)在正常值95%可信区间内.6例存有主动脉瓣轻度反流;肺动脉瓣上狭窄极轻度3例,轻度狭窄1例;2例存有肺动脉瓣轻度反流.结论超声心动图随访结果证实目前在本中心开展ASO治疗TGA等复杂性先天性心脏病术后左心室功能良好,新主动脉根部和瓣环有所扩张,新肺动脉根部和瓣环发育良好.

Objective To evaluate left ventricle function and size of the great arteries after the arterial switch operation （ ASO ） for transposition of the great arteries （ TGA ）. Methods 16 cases with TGA/IVS （ n = 8 ） , TGA/VSD （ n = 6 ） and Taussig Bing abnormality （ n =2） were examined at 4 - 37 months [ （ 19. 6 ± 11.1 ） m] after ASO by using Mmode,2D,Doppler and color Doppler echocardiography. The outcome data were compared with normals. Results Left ventricle function was normal in all. Endsystolic diameter of neo-aortic valve annulus and root beyond 95% confidence interval for normal values were in 10 cases （62. 5% ） and 14 cases （87.5%） respectively. The diameter of neo-pulmonary valve annulus and root in 95% confidence interval for normal values were in 10 cases （62. 5% ） and 9 cases （56. 25% ） respectively. Mild aortic regurgitation was observed in 6 cases （ 37.5% ）. No correlation was found between aortic and aortic regurgitation dilatation. Neo-aortic stenosis was not observed. Mild supravalvular pulmonary stenosis happened in 4 cases （25.0%） ,pulmonary regurgitation in 2 cases （ 12.5% ）. Conclusion Mid-term follow-up after ASO for TGA reveals satisfactory outcome of left ventricle function and dilation of neo-artery root and annular.