新型冠状病毒肺炎疫情以来单中心完全性大动脉转位救治经验

The treatment experience of single-center complete transposition of great arteries since the epidemic situation of corona virus disease-19

目的总结新疆维吾尔自治区第三人民医院新型冠状病毒肺炎疫情以来完全性大动脉转位(TGA)救治经验。方法回顾性选取2020年1月至2021年12月新疆维吾尔自治区第三人民医院收治的9例TGA患儿,其中男5例、女4例,手术年龄15 d至11个月29 d,体质量2.3~5.4 kg。患儿术前均行超声心动图及多普勒超声检查进行确诊,合并室间隔缺损(VSD)4例,室间隔完整型(IVS)5例,合并动脉导管未闭(PDA)6例,合并房间隔缺损(ASD)8例。分析9例患儿临床救治情况。结果9例TGA患儿中,1例因单支冠状动脉畸形,术后死于低心排血量综合征;1例因合并主动脉弓畸形,术中主动脉弓处理效果不佳,于术后11 d放弃治疗自动出院。并发症包括1例Ⅲ度房室传导阻滞,1例乳糜胸,1例胸骨哆开重新固定,经处理后均痊愈出院。随访3个月至1年,1例自动出院患儿于转运途中死亡,1例于家中猝死,其余均恢复良好,暂未出现主动脉瓣反流及肺动脉吻合口梗阻等。结论新型冠状病毒肺炎疫情以来新疆维吾尔自治区第三人民医院对于正常型冠状动脉的单纯TGA救治效果良好,复杂型冠状动脉及合并主动脉弓病变的TGA救治疗效欠佳。

Objective To summarize the treatment experience of transposition of great arteries(TGA)since the epidemic situation of corona virus disease-19 in the Third People′s Hospital of Xinjiang Uygur Autonomous Regions.Methods A total of 9 children with TGA admitted to the Third People′s Hospital of Xinjiang Uygur Autonomous Region from January 2020 to December 2021 were retrospectively selected.There were 5 boys and 4 girls,with 15 d to 11 months 29 d in age and body weight 2.3-5.4 kg.The diagnosis was confirmed by echocardiography and Doppler,and 4 cases had ventricular septal defect(VSD),5 cases had intact ventricular septum(IVS),6 cases had patent ductus arteriosus(PDA),and 8 cases had atrial septal defect(ASD).The clinical treatment of 9 cases was analyzed.Results Among 9 cases of TGA,1 case had a single coronary artery malformation,and the child died of low cardiac output syndrome after operation;1 case had an aortic arch malformation,which had a poor effect on aortic arch treatment during operation,and was discharged automatically 11 d after operation.Complications included 1 case of third-degree atrioventricular block,1 case of chylothorax,and 1 case of sternal dehiscence re-fixation,all of which recovered and were discharged after treatment.During a follow-up of 3 months to 1 year,1 case discharged automatically and died during transport,1 case died suddenly at home,and the others recovered well.There were no aortic valve insufficiency and anastomotic stenosis of the pulmonary artery.Conclusions Since the epidemic situation of corona virus disease-19,the Third People′s Hospital of Xinjiang Uygur Autonomous Region has had a good effect on the treatment of simple TGA in normal coronary arteries,while the treatment of complex coronary arteries and TGA with aortic arch lesions is not effective.