73例大动脉调转术非典型冠状动脉解剖类型分析

Analyzing types of atypical coronary artery anatomy in 73 cases of arterial switch operation

目的分析73例大动脉调转术非典型冠状动脉解剖类型，从临床角度探讨其分类和描述。方法2001年1月至2008年12月，采用大动脉调转术治疗完全性大动脉转位伴室间隔缺损型（TGA／VSD）38例，完全性大动脉转位伴室间隔完整型（TGA／IVS）35例。根据术中所见冠状动脉解剖，采用Leiden分类标准进行分类，图例参考Marie—Lannelongue医院绘制图例制作。结果非典型冠状动脉17例，发生率约23％，其中TGA／VSD10例，TGAZIVS7例。根据Leiden分类标准可分9类，但有12种描述，7例Leiden标准尚不能准确的分类或全面的描述。结论TGA病儿非典型冠状动脉的发生率较高，类型多样，其中有较多的解剖类型Leiden标准尚不能准确描述，为便于临床手术操作，对于非典型冠状动脉的解剖最好是Leiden分类结合补充描述的方法。

Objective Analyzing types of atypical coronary arterial anatomy in 73 patients with arterial switch operation, from the point view of clinical application to its classification and delineation. Methods Between January 2001 and December 2008, 38 patients with complete transposition of great arteries and ventrictdar septal defect （TGA/VSD） and 35 patients with complete transposition of great arteries and intact ventricular septum （TGA/IVS） were repaired by arterial switch operation. Based on operation findings of coronary arterial anatomy, we used Leiden criteria for classification, and referred Planch＇s Marie-Lannelongue Hospital image model to draw pictures. Results There were 17 atypical coronary arterial anatomy in total cases, with a ratio of 23%. Ten cases were in TGA/VSD group and 7 in TGA/IVS group. According to the classification standard 9 groups and 12 sorts of delineations were divided. However, if based on Leideng classification standard, 7 cases could not be precisely classify or delineate. Conclusion Patients with transposition of great artery have a high incidence of atypical coronary artery. Leiden＇ s classifying method could not precisely classifed or delineated them. For clinical convenience, we advocate Leiden＇s classification method and combine with complementary delineation.