大动脉转换术治疗完全性大动脉错位27例

Arterial switch operation for complete transposition of great arteries in 27 cases PENG

目的回顾性总结我院采用大动脉转换术（ASO）治疗完全性大动脉错位的疗效。方法2004年4月至2008年12月．应用大动脉转换术治疗完全性大动脉错位（D—TGA）27例，其中〈2周11例，〈4周8例，〈6个月4例，〈1岁3例，〉1岁1例。室间隔完整型大动脉错位（D—TGA／IVS）19例，其中快速二期4例。大动脉错位合并室间隔缺损（D—TGA／VSD）8例。所有患者均在经鼻气管插管全麻深低温低流量体外循环下行ASO。结果全组死亡5例，病死率18．5％。其中TGA／IVS15例，死亡2例，1例为肺出血，1例为重度黄疸、肝功能衰竭。TGA／IVS快速二期4例，无死亡。TGA／VSD 8例，死亡3例，2例合并冠状动脉畸形，1例死于出血。22例随访3～56个月，心功能均正常，残余主动脉轻度梗阻1例，肺动脉轻度梗阻3例。结论大动脉转换术治疗TGA效果良好。适当的手术时机和冠状动脉的完美转移是手术成功的关键。

Objective To review the effect of arterial switch operation （ASO） for complete transposition of great arteries in our hospital from April 2004 to December 2008. Methods Twerty - seven cases of complete transposition of great arteries （TGA） were repaired by the ASO between April 2004 and December 2008. There were 19 patients with trans- position of great arteries with intact ventricular septal （TGA/IVS）, age from 6 to 120 [ average （21.7± 13.6）] days, weight from 2.8 to 5.4 （ 3.6±0.5 ） kg. And there were 8 patients of transposition of great arteries with ventricular septald defect （ TGA/VSD）, age from 9 to 72 [ average （41.0±26.5 ） ] days, weight from 3.1 to 5.3 average （ 3.8±0.4） kg, except one case of 4 years. All cases underwent ASO under uhrafiltration and modified uhrafiltration, deep hypothermic low flow CPB. Results There were 5 deaths （ 2 from TGA/IVS group and 3 from TGA/VSD group） and no death in rapid two - stage ASO. The hospital mortality was 18.5%. 22 survivors were followed - up. One patient had residual ascending aorta obstruction and 3 patients had mild pulmonary obstruction. Conclusions Arterial switch operation can be performed in congenital transposition of great artery. The key is operative opportunity and perfect transfer of the coronary arteries.