矫正型大动脉转位合并心内畸形的外科治疗

Surgical treatment of corrected transposition of great arteries combined with heart malformation (35 cases report)

目的 :总结我院 1984年 4月至 2 0 0 0年 7月收治的 35例矫正性大动脉转位 (correcttransposi tionofgreatartery ,CTGA)合并心内畸形的外科治疗。方法 :35例CTGA患者中 ,SLL型 30例 ,占 85 7% ,IDD型 5例 ,占 14 3%。合并畸形包括室间隔缺损 (ventricleseptumdefect,VSD) ,肺动脉瓣狭窄 (pulmonarystenosis,PS) ;右室流出道狭窄 (rightventricularoutflowtractobstacle ,RVOTO) ,房间隔缺损 (atrialseptumde fect;ASD) ,二尖瓣关闭不全 (mitralinsufficiency,MI)等。其中以VSD最多 ,占 83.3% ,PS次之 ,占 5 1 4 %。全部患者均在全麻中度低温下行心内直视手术矫正各种心内畸形。结果 :手术成功率 94 3% ,死亡率5 71% ,主要死亡原因为术后低心排 ,肺部感染等。Ⅲ度房室传导阻滞 (Ⅲ度A VB)发生率 11.4 %。结论 :我们认为 :1 选择合适的心脏切口对VSD ,PS及RVOTO的处理非常重要 ,术中应避免损伤冠状动脉主要分支及房室传导束。 2 修补VSD时于其前上方应缝在解剖右室面 ,以免损伤传导束。 3 应彻底解除PS及RVOTS 。

Objective:to sum up our experiences of surgical treatments of corrected transposition of great artery (CTGA) associated with other heart malformations.Method:From Aprial 1984 to July 2000,there were 35 cases of CTGA associated with other heart anomalies were performed surgical treatments. Among them, Type SLL: 30 cases(85 7%),Type LDD:5 cases(14.3%).The heart abnormalities include ventricular septal defect(VSD); Pulmonary stenosis(PS); Right ventricular outflow tract obstruction(RVOTO); atrial septal defect(ASD) and mitral insufficiency (MI) etc. In which, the most is VSD (83%),Second is PS or RVOTO(51 4%).All of patients were operated under hypothermic cardiac pulmonary bypass(CPB).Result:Mortality is 5 71%, the main reasons of death were low heart output syndrome and pulmonary infection. Rate of occurring Ⅲ° atrial ventricle block(A VB) is 11.4%.Conclusion:1. It is important to choice heart incision in order to repair VSD,PS and RVOTO, during operation, Should avoid injuring main bundle of coronary artery and conduction branches; 2. It is very important to prevent from occurrence of Ⅲ°A VB, We should suture anterosuperior of VSD in the section of anatomy right ventrium in case of injuring conduction branches; 3.It is very important to release obstacles of outflow tract of right ventrium in order to prevent from right ventricle failure.