主动脉移位术纠治婴幼儿完全性大动脉错位伴室间隔缺损和肺动脉狭窄

Aortic translocation for transposition of the great arteries with ventricular septal defect and pulmonary stenosis

目的 探讨主动脉移位术纠治完全性大动脉错位伴室间隔缺损和肺动脉狭窄（TGA／VSD／PS）的临床应用。方法 2004年8月到2005年7月，采用主动脉移位术连续纠治6例TGA／VSD／PS，其中男5例，女1例；年龄4～24个月，平均（11．33±6．86）个月；体重5．6～11．0ks，平均（8．43±2．19）ks。结果 无手术死亡。体外循环转流112～204min，平均（153．83±33.70）min，主动脉阻断73～139min，平均（89．16±18．61）min。术后随访2～12个月。6例病儿活动良好，X线胸片示心影较术前略大，肺血增多；心电图示窦性心律，心脏超声检查示主动脉瓣反流轻微2例，轻度1例。射血分数0．74～0．86，短轴缩短率O．34～0．52。结论 当前TGMVSD／PS普遍采用Rastelli手术，但长期随访发现术后并发症较多，结果尚不理想。主动脉移位术重建左心室流出道和右心室流出道，避免了Rastelli手术后左心室流出道梗阻和心外管道梗阻的并发症。

Objective To review the clinical treatment of the aortic translocation operation for complete tin.position of the great arteries with ventricular septal defect and pulmonary stenosis （TGA/VSD/PS）. Methods Between August 2004 and July 2005, Six patients with TGAIVSDIPS were surgical repaired by the aortic translocation operation. There were 5 males and 1 female. The operative age was from 4 months to 2 years [ mean age （ 11.33 ± 6.86 ） months ] and the weight was from 5.6 ～ 11.0 kg [ mean weight （8.43±2.19） kg]. Results The mean totalbypass time was （153.83 ± 33.70） min （range from 112～204 min）, and the mean cross-clamp time was （89.16±18.61 ） min （range from 73～139 min）. There was no hospital death. All survived and were followed up from 2 months to 1 year. The chest X-ray showed that the heart was a little enlarged and the pulmonary vascular marking was increased. ECG showed sinus rhythm. There were trivial aortic insufficiency in two patients and mild aortic insufficiency in one. The ventricular function was normal, EF 0.74～0.86, FS 0.34～0.52. Condusion Rastelli repair is popular for the treatment of TGM VSD/PS, but the long-term results are not satisfying. The aortic translocation and biventricular outflow tract reconstruction is a valuable procedure to avoid the occurrence left ventricular outflow tract obstruction and extra-cardiac conduit obstruction after Rastelli operation. A longer follow-up is needed in estimation.