动脉调转术195例冠状动脉分型及疗效分析

Classification of Coronary Artery Anatomy and Surgical Outcomes in 195 cases of Arteries Switch Operation

目的：总结行动脉调转手术（ASO）患者的冠状动脉分型，并探讨其相应的手术方法和疗效。方法：回顾分析2000年6月至2007年6月195例行ASO患者资料，其中室隔完整型大动脉转位（TGA／IVS）62例，室隔缺损型大动脉转位（TGA／VSD）86例，Taussing—Bing畸形（TBN）33例，先天性矫正型大动脉转位（CCTGA）14例。主动脉位于肺动脉右前98例（50．3％），正前44例（22．6％），左前37例（19．0％），左右并列16例（8．2％）。采用Leiden冠状动脉分型方法对195例患者进行分类。ASO术中采用标准冠脉移植法179例，单窦主动脉冠状动脉片移植11例，冠状动脉旁路移植术（CABG）2例，其他移植方法3例。结果：1Lad，Cx；2R为冠脉正常分布，共139例（71．3％），其他类型为冠脉异常分布，共56例（28．7％）。全组手术死亡25例，总死亡率为12．8％；冠状动脉正常分布者死亡率10．1％（14／139），异常分布者死亡率19．6％（11／56）。5例患者死亡与冠状动脉异常分布相关。170例患儿存活，除1例发生脑缺氧昏迷后遗症外，余均痊愈出院。随访（14．5±7．6）个月，心功能明显改善。1例术后1年半因肺动脉吻合口狭窄再次手术，余患者无死亡和远期并发症发生。结论：目前多数常见冠脉异常分布的移植已取得满意效果，但壁内冠状动脉及罕见异常分布冠脉移植死亡率仍高，术中应仔细观察，注意避免发生冠脉损伤。

Objective：To summarize the coronary artery （CA） pattern and explore the surgical technique and clinical outcome of arterial switch operation （ASO）. Methods：The data was from 195 patients accepted ASO from June 2000 to June 2007, among which 62 cases of transpositions of the great arteries with intact ventricular septum （TGA/IVS） ,86 of TGA and ventricular septal defect （TCA/VSD） ,33 of Taussing-Bing anomaly（TBN） , 14 of congenitally corrected TGA （CCTGA）. The aortas were situated at right anterior of pulmonary arteries in 98 cases（50.3% ） ,at directly anterior in 44（22.6% ） ,left anterior in 37（ 19.0% ） ,side by side in 16（8.2% ）. The Leiden method for typing of CA was adopted in this study. Standard transplantation of CA was performed on 179 cases, single ostia aortoeoronary flap transplantation in 11, coronary artery bypass grafting（CABC） in 2, other transplantations in 3. Results：The normal distribution of CA [ 1Lad,Cx;2R] was observed in 139 patients（71.3% ）, abnormal distribution in 56 （28.7%）. The total mortality was 12.8% （25 cases）, including 14 cases （ 10. 1% ） with normal distribution of CA, 11 （ 19.6% ） with abnormal. There were 5 cases died of abnormal CA patterns. Except for one patient happened sequela of cataphora due to cerebral anoxia, the survivors（ 170 cases） left hospital satisfactorily. In the period of follow-up（ 14.5 ± 7.6 months） , one received reoperation for the pulmonary anastomotie stoma stenosis, other survivals did not happen any long-dated complications, their heart function obviously improved. Conclusions：The surgical outcome for most abnormal CA patterns is satisfied at present. However the mortality of transplantation for intramural course and some scarce CA patterns is higher, more attentions should be paid to avoid injury of CA.