Patients with complete transposition of the great arteries(TGA)treated by the Senning procedure have a higher risk of developing heart failure due to:a)additional work load of the systemic(morphologic right)ventricle(...Patients with complete transposition of the great arteries(TGA)treated by the Senning procedure have a higher risk of developing heart failure due to:a)additional work load of the systemic(morphologic right)ventricle(sRV),b)arrhythmias,mainly caused by surgical implications at the atria as well as c)worsening of systemic tricuspid regurgitation.We present a unique case of a female patient who developed all these complications,who was successfully treated and was able to carry out a twin pregnancy.This breakthrough approach was based on:1.detecting reversibility potential of myocardial systolic dysfunction in a severe valvular lesion combined with continuous systemic afterload settings and permanent tachyarrhythmia,and 2.prevention of subsequently iatrogenic worsening of systemic ventricular function due to permanent pacing.Surgical replacement of systemic tricuspid valve(sTV)and cardiac resynchronization device(CRT)implantation after nodal ablation resulted in recovering of the systolic function and a positive remodeling of the sRV.The reversal of a further decline in systolic function was achieved by permanent arrhythmia control,synchronous pacing with epicardial leads of CRT,sTV replacement as well as echocardiographic monitoring during pregnancy to determine the right time for delivery.Two years after delivery,the patient remains in NYHA Class I.展开更多
目的分析大动脉转位术(arteria l sw itch operation,A SO)治疗完全性大动脉错位(com p letetranspos ition of the great arteries,TGA)的手术结果,探讨影响死亡率的危险因素。方法收集2003年1月至2004年12月期间,我院对67例TGA患者施...目的分析大动脉转位术(arteria l sw itch operation,A SO)治疗完全性大动脉错位(com p letetranspos ition of the great arteries,TGA)的手术结果,探讨影响死亡率的危险因素。方法收集2003年1月至2004年12月期间,我院对67例TGA患者施行A SO的临床资料,包括住院病历、超声心动图和手术记录。应用2χ检验和log istic多变量回归分析对患者的手术年龄、体重、诊断、冠状动脉分型、体外循环时间、主动脉阻断时间、停循环时间、术后呼吸机辅助时间、延迟关胸等因素进行统计分析,分析影响死亡率的危险因素。结果施行A SO的67例TGA患者中,围手术期死亡5例(7.5%)。单变量分析结果表明,影响A SO死亡率相关的危险因素有:年龄(P=0.004)、体重(P=0.042)、冠状动脉分型(P=0.006)和体外循环时间(P=0.048)。伴有室间隔缺损(ven tricu lar septa l defect,V SD)的患者(TGA/V SD)术后住心脏监护室(C ICU)时间(P=0.004)和术后住院时间(P=0.007)明显长于室间隔完整(in tact ven tricu lar septum,IV S)的患者(TGA/IV S)。log istic多变量回归分析结果表明,患者手术时年龄(P=0.012)、冠状动脉畸形(P=0.001)和较长的体外循环时间(P=0.002)是影响A SO死亡率的危险因素。结论对TGA患者及时施行A SO可获得良好的临床效果,患者手术时年龄、冠状动脉畸形和较长的体外循环时间是影响死亡率的危险因素。展开更多
文摘Patients with complete transposition of the great arteries(TGA)treated by the Senning procedure have a higher risk of developing heart failure due to:a)additional work load of the systemic(morphologic right)ventricle(sRV),b)arrhythmias,mainly caused by surgical implications at the atria as well as c)worsening of systemic tricuspid regurgitation.We present a unique case of a female patient who developed all these complications,who was successfully treated and was able to carry out a twin pregnancy.This breakthrough approach was based on:1.detecting reversibility potential of myocardial systolic dysfunction in a severe valvular lesion combined with continuous systemic afterload settings and permanent tachyarrhythmia,and 2.prevention of subsequently iatrogenic worsening of systemic ventricular function due to permanent pacing.Surgical replacement of systemic tricuspid valve(sTV)and cardiac resynchronization device(CRT)implantation after nodal ablation resulted in recovering of the systolic function and a positive remodeling of the sRV.The reversal of a further decline in systolic function was achieved by permanent arrhythmia control,synchronous pacing with epicardial leads of CRT,sTV replacement as well as echocardiographic monitoring during pregnancy to determine the right time for delivery.Two years after delivery,the patient remains in NYHA Class I.
文摘目的分析大动脉转位术(arteria l sw itch operation,A SO)治疗完全性大动脉错位(com p letetranspos ition of the great arteries,TGA)的手术结果,探讨影响死亡率的危险因素。方法收集2003年1月至2004年12月期间,我院对67例TGA患者施行A SO的临床资料,包括住院病历、超声心动图和手术记录。应用2χ检验和log istic多变量回归分析对患者的手术年龄、体重、诊断、冠状动脉分型、体外循环时间、主动脉阻断时间、停循环时间、术后呼吸机辅助时间、延迟关胸等因素进行统计分析,分析影响死亡率的危险因素。结果施行A SO的67例TGA患者中,围手术期死亡5例(7.5%)。单变量分析结果表明,影响A SO死亡率相关的危险因素有:年龄(P=0.004)、体重(P=0.042)、冠状动脉分型(P=0.006)和体外循环时间(P=0.048)。伴有室间隔缺损(ven tricu lar septa l defect,V SD)的患者(TGA/V SD)术后住心脏监护室(C ICU)时间(P=0.004)和术后住院时间(P=0.007)明显长于室间隔完整(in tact ven tricu lar septum,IV S)的患者(TGA/IV S)。log istic多变量回归分析结果表明,患者手术时年龄(P=0.012)、冠状动脉畸形(P=0.001)和较长的体外循环时间(P=0.002)是影响A SO死亡率的危险因素。结论对TGA患者及时施行A SO可获得良好的临床效果,患者手术时年龄、冠状动脉畸形和较长的体外循环时间是影响死亡率的危险因素。
