56例大动脉调转术的冠状动脉解剖分型和早期手术效果分析  

Analysis of coronary artery anatomy pattern in 56 arterial switch operations and early outcome

作　　者：叶赞凯[1] 刘迎龙[1] 李志强[1] 范祥明[1] 杨学勇[1] 

机构地区：[1]首都医科大学附属北京安贞医院北京市心肺血管疾病研究所小儿心脏科,北京100029

出　　处：《中华胸心血管外科杂志》2014年第5期266-268,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的分析56例大动脉调转术的冠状动脉解剖分型和早期手术效果的关系。方法2010年5月至2013年9月，56例完全型大动脉转位合并其他畸形患儿接受手术治疗。男39例，女17例；出生后5天～126个月。其中室间隔完整型19例，伴室间隔缺损36例，右心室双出口伴肺动脉瓣下室间隔缺损1例。合并房间隔缺损33例（含卵圆孔未闭），动脉导管未闭26例，重度肺动脉高压20例，肺动脉瓣狭窄2例，主动脉弓缩窄1例。所有患儿均接受大动脉调转术，术中均探查冠状动脉并行冠状动脉移植术。结果冠状动脉YacoubA型46例：术后30天内死亡4例；YacoubB型5例，术后30天内死亡2例；YacoubC型2例，其中1例术后当天因低心排咀量综合征死亡；YacoubD型1例和YacoubE型2例，术后30天均无死亡。结论常见的冠状动脉畸形行大动脉调转术早期死亡比例未增加，存在单冠畸形和壁内冠状动脉会增加大动脉调转手术的早期死亡比例。Objective This study was designed to investigate the relationship of the coronary anatomy pattern in 56 arterial switch operation （ASO） with the early outcome. Methods From May 2010 to September 2013, a total of 56 patients with transposition of the great arteries complicated with other defomities （39 males and 17 females, with age of 5 days to 126 months） ,who were undertook ASO in Capital Medical University affiliated Beijing Anzhen Hospital . There were 19 patients with complete transposition of the great arteries and intact ventricular septum ,35 patients with complete transposition of the great arteries and ventricular septal defect, and 1 patient with double outlet right ventricle with subpulmonary ventricular septal defect （Taussing-Bing）. 33 were complicated with atrial septal defect and 26 with patent ductus arteriosus,20 had severe pulmonary hypertension ,2 had pumonic valve stenosis and 1 had coaretatioin of aorta. All patients undertook ASO, coronay distribution were detected during the procedure and coronary artery were grafed. Results Coronary artery ： Yacoub type A were 46 cases ： 4 patients died during the 30 days after the operation,Yacoub type B were 5 cases： 2 patients died. Yacoub type C were 2 ca- ses ： 1 died of low cardiac output on the operating day. Yacoub type D were 1 case and Yacoub type E were 2 cases ： none of them died. Conclusion Patients with common coronary variants have undergone ASO without added mortality rate. Those with intramural or single coronary arteries have significant added mortality rate.

关 键 词：大动脉调转术 室间隔缺损 

分 类 号：R725.4[医药卫生—儿科]