同种带瓣主动脉用于矫正型大动脉转位合并肺动脉狭窄手术治疗

Surgical Treatment of Corrected Transposition of Great Arteries with Pulmonary Arterial Stenosis by Aortic Valved Homograft

目的将同种带瓣主动脉经过适宜处理后，用以治疗１８例合并肺动脉狭窄的矫正型大动脉转位（ＣＴＧＡ）患者，其中内脏正位（ＳＬＬ）型１４例，内脏反位（ＩＤＤ）型４例，均合并室间隔缺损（ＶＳＤ）。方法手术缝闭肺动脉瓣口，修复ＶＳＤ，用经过冷冻处理的同种带瓣主动脉管道连接功能右心室和肺动脉。结果术后测压：右心室收缩压为３．３～６．４ｋＰａ（２５～４８ｍｍＨｇ），右心室－肺动脉压差０．６６～３．０ｋＰａ（５～２２ｍｍＨｇ），右心室／左心室压比值０．３～０．６。结论采用同种带瓣主动脉能使患者术后血流动力学指标更接近于人体正常生理状态。

Objective After being suitably managed, aortic valved homografts have been used in surgical treatment for 18 patients of corrected transposition of great arteries(CTGA) with pulmonary arterial stenosis. These patients were all complicated with ventricular septal defects. Of them, 14 patients were SLL type, the other 4 patients were attributed to IDD type. Methods Operations were performed including directly closing pulmonary stenosis,repairing ventricular septal defects with a patch and connecting anatomical left ventricle to pulmonary artery by an aortic valved homograft. Results Postoperative measurements showed that right ventricular systolic pressures were 3.3-6.4 kPa(25～48mmHg), pressure gradients between right ventricle and pulmonary artery were 0.66-3.0 kPa(5～22mmHg), and ratios of right ventricular pressure to left ventricular pressure were 0.3-0.6 respectively. Conclusion The postoperative hemodynamics indexes of the patients with this surgical procedure were further close with the normal physical levels.