Double—Switch手术纠治房室连接不一致的复杂先天性心脏病

Double-Switch operation in corrected transposition and double outlet right ventride with atrioventricular discordance

目的回顾和总结Double-Switch手术方法的临床应用体会。方法从2002年1月至2006年12月，采用Double-Switch方法纠治房室连接不一致复杂型先天性心脏病（先心病）共14例。其中男11例，女3例；手术年龄3个月-7岁，平均（39．0±35．27）个月；体重5—31kg，平均（14．23±8．27）ks。包括纠正型大血管错位9例，房室连接不一致型右心室双出口5例。10例伴肺动脉狭窄，采用Senning＋Ras—telli手术；余4例采用Senning＋Switch手术。结果死亡2例，为采用Senning加Rastelli手术者。全组无发生完全性房室传导阻滞者。生存病儿随访2个月-5年，远期死亡1例。Senning＋Rastelli手术后出现心室内0．2cm残余分流1例，上腔静脉回流流速增快2例，分别为1．8m／s和2．16m／s，心功能均在正常范围，继续随访中。Senning加Switch手术者随访结果满意，无任何残余分流和梗阻。结论Double-Switch手术纠治房室连接不一致的复杂型先心病，结果较好，但仍需进一步随访以观察长期疗效。

Objective To review the experience of double-switch operation in corrected transposition and double outlet fight ventricle with atrioventricular discordance. Methods Between January 2002 and December 2006, fourteen patients with atrioventrieular discordance received double-switch operation. There were 11 boys and 3 girls, aged 3 months to 7 years [ mean （39.130 ± 35.27） months], and the body weight, 5 - 31 kg [mean （14.23 ± 8.27） kg]. There were 9 patients with corrected transposition and 5 patients with double outlet right ventricle with atrioventricular discordance. Ten patients with puhnonary stenosis were repaired by Senning ＋ Rastelli operation and 4 patients without pulmonary stenosis, by Sonning ＋ Switch operation. Results There were 2 deaths in Senning ＋ Rastelli operation group and no death in Senning ＋ Switch operation group. The total mortality was 14.28%. No complete atrioventricle block occurred. All patients were followed up from 2 months to 5 years, and one patient died at 3 months postoperatively because of tricuspid valve regurgitation. One patient had residual VSD about 0.2 cm, 2 patients had SVC mild obstruction with flow rate 1.8 m/s and 2.16 m/s. All these patients had good heart function during follow-up. Conclusion The double switch operation can be performed in selected patients with minimal early morbidity and mortality. Longer follow-up is to determine whether this complex approach is indeed warranted.