超声心动图在完全性大动脉转位患者快速二期大动脉调转手术时机判断中的作用

The role of echocardiography in surgical decision making in rapid two-stage arterial switch operation for patients with transposition of great arteries

目的评价超声心动图在完全性大动脉转位(D-TGA)患者快速二期大动脉调转手术时机判断中的作用。方法13例D-TGA患者行肺动脉环扎锻炼左心室心肌,然后行大动脉调转术(ASO)。应用超声心动图观察手术前、后左心室的变化。结果肺动脉环缩平均(10.0±3.5)d后行ASO,10例(76.9%)手术成功,3例(23.1%)死亡。手术前左心室压力低,胸骨旁短轴观显示室间隔突向左心室面,呈“香蕉”形。肺动脉环缩后左、右心室压力比从0.42±0.18上升至0.83±0.08(P<0.01),左心室质量指数从(29.0±10.6)g/m2上升至(69.6±18.6)g/m2(P<0.01);除了3例死亡患者,其他病例室间隔均突向右室面,左心室呈圆形,左心室舒张末期直径(LVDD)从(1.82±0.39)cm上升至(2.24±0.28)cm(P<0.05)。而3例死亡患者LVDD无明显变化,室间隔仍较平直。结论对室间隔完整或合并小型室间隔缺损的大年龄D-TGA患者,肺动脉环扎10d左右、左心室质量指数大于50g/m2可行快速二期大动脉调转术。肺动脉环扎后LVDD明显增加,胸骨旁短轴观显示室间隔突向右心室面、左心室呈圆形者手术效果较好。

Objective To evaluate the role of echocardiography in surgical decision making in rapid two-stage arterial switch operation for patients with transposition of great arteries（D-TGA）. Methods Thirteen patients with D-TGA underwent pulmonary artery banding and aortopulmonary shunt to prepare the left ventricle for the arterial switch operation. Doppler echocardiography was performed in the interval phase to assess left ventricular changes. Results Thirteen patients underwent arterial switch operation after a mean intervals of （10.0±3.5） days after pulmonary artery banding, with 10 （76.9%） successful conversions. There were 3 mortality（23.1%）. In all patients a mean increase in left ventricular to right ventricular pressure ratio （0. 42 ± 0.18 to 0.83 ± 0.08） and left ventricular mass index[（29.0 ± 10.6）g/m^2 to （69.6 ± 18.6）g/m^2] ware recorded. All patients had a right to left bulging of the interventricular septum with a ＂banana＂ shape before pulmonary artery banding. In all successful patients the left ventricle had a circular shape, in the three failure the interventricular septum had remained flat. Left ventricular diastolic dimension（LVDD） increased in all except the three switch failure. Conclusions The rapid two-stage arterial switch operation is applicable for older patients with D-TGA with intact ventricular septum or small ventricular septal defect, increase in LVDD, and an acquisition of circular left ventricular configuration appear to best predict successful outcome.