大动脉转位患儿行大动脉调转术后的中长期随访

Mid-to-long-term outcomes of the arterial switch operation in children with transposition of great arteries

目的 探讨大动脉调转术（ASO）治疗大动脉转位（TGA）患儿的中、长期疗效,及观察术后主动脉瓣反流及吻合口梗阻情况.方法 以2003年1月至2009年12月在本研究所行ASO的TGA患儿166例为研究对象,按室间隔是否完整分为TGA合并室间隔缺损组（Ⅰ组）94例、TGA并室间隔完整组（Ⅱ组）72例.所有术后生存患儿均进行随访,超声心动图观察主动脉瓣反流及吻合口梗阻情况.结果 Ⅰ组和Ⅱ组分别有14例和10例患儿住院死亡.所有术后生存患儿平均随访时间（57.41±15.45）个月.随访发现51例患儿出现主动脉瓣反流,多发生于术后3～5年.相关性分析显示主动脉瓣反流面积与随访时间呈正相关（r=0.436,P=0.028）.所有随访病例没有出现主动脉吻合口梗阻（压差＞50 mm Hg,1 mm Hg=0.133 kPa）.Ⅰ组和Ⅱ组肺动脉吻合口梗阻（压差＞50 mm Hg）的发生率分别为6.25％（5/80）和3.23％ （2/62）.结论 ASO是治疗TGA的理想术式,具有良好的中、长期疗效.术后定期随访有助于改善患儿的长期预后.

Objective To investigate the mid-to-long-term outcomes as well as development of aortic valve regurgitation and stenosis following aortic and pulmonary anastomosis after arterial switch operation （ASO） in children with transposition of the great arteries （TGA）.Methods A total of 166 TGA children who underwent ASO in our institute between January 2003 and December 2009 were included in this study.The patients with ventricular septal defect （VSD） were allocated to Group Ⅰ （n=94） and those with intact ventricular septum to Group Ⅱ （n=72）.All the patients were followed up in out-patient department by echocardiogram for aortic valve regurgitation and stenosis following aortopulmonary anastomosis.Results Fourteen patients from Group Ⅰ and 10 from Group Ⅱ died after ASO respectively.The mean length of follow-up was （57.41±15.45） months.Neoaortic valve regurgitation was detected in 51 cases,mostly within 3 to 5 years post-ASO.Correlation analysis revealed that the reflux area was positively correlated with the length of follow-up （r=0.436,P=0.028）.Aortic anastomotic stenosis （defined as pressure gradient ＞50 mm Hg,1 mm Hg=0.133 kPa） did not occur in all the patients,whereas pulmonary anastomotic stenosis （defined as pressure gradient ＞50 mm Hg） was found in 6.25％ and 3.23％ respectively,of patients during follow-up from Group Ⅰ （5 out of 80） and Group Ⅱ （2 out of 62）.Conclusions ASO may be an ideal surgical option for TGA,with good mid-to-long-term outcomes.Regular post-surgical follow-up will help ensure a better prognosis after ASO.