肺动脉窦壁“L”形切口冠状动脉移植在大动脉调转术中的应用

Coronary artery implantation of arterial switch operation--＂L＂ shape incision at the pulmonary artery wall

目的总结肺动脉窦壁“L”形切口行冠状动脉移植在大动脉调转术中的应用体会。方法采用在肺动脉窦壁做“L”形切口的方法行大动脉调转术（ASO）治疗心室大动脉连接异常病儿25例，其中4例为快速两期ASO治疗，男16例，女9例；年龄6d～66个月；体重2．5～15．0ks，平均（4．7±2．9）ks。完全性大动脉转位（D-TGA）19例，其中室间隔完整型（TGA-IVS）10例，室间隔缺损（TGA-VSD）9例；右室双出口伴肺动脉瓣下室间隔缺损（Taussig-Bing，TBA）6例。术中冠状动脉移植采用在相应邻近的肺动脉窦壁做“L”形切口，形成“门板状”活瓣的方法。结果全组手术中开放升主动脉后心脏自动复跳，未发现心肌缺血的心电图和临床表现。术后早期循环均稳定。术后早期死亡4例，均与冠脉移植无明确关系。结论采用“L”形切口进行冠脉移植，可以相对增加冠状动脉的长度，减少游离冠状动脉范围，减小张力，同时可以减轻冠状动脉移植后的扭曲。

Objective To report the preliminary experience d using ＂L＂ shape incision of the pulmonary artery wall for coronary artery implantation of arterial switch operation （ASO）. Methods Between September 2004 and January 2007, 25 patients with TGA and IVS/VSD, or TBA were corrected surgically by ASO. Rapid two-stage ASO was done in 4 cases. The operation was performed under conventional anesthesia and extracorpored circulation without deep hypothermia and low-flow perfusion. The coronary buttons were implanted in trap-dour incisions （the incision of ＂L＂ shape） at the adjacent pulmonary artery wall. Results The heart beat recovered spontaneously and there was no episode of clinical myocardial ischemia during the early postoperative period. 4 postoperative deaths were not related to without myocardial ischemia. 16 cases have been followed up for 1 - 28 months. Heart function was grade I - lI in all patients. Conclusion ＂L＂ shape incision is preferable to making hole or ＂U＂ shape excision at the adjacent pulmonary artery wall. It increases the longth and decreases the chance of kinking of the cot＇unary artery after implanted.