小儿ccTGA解剖纠治术中应用双向Glenn/半Mustard心房调转双调转手术的初步研究
The clinical research of double switch operation with Glenn and hemi-Mustard in CC-TGA in children
目的 评估先天性矫正型大动脉转位中应用半Mustard心房调转手术及双向Glenn手术完成双调转手术的风险及收益.方法 为了避免完全Senning手术的并发症并且辅助右心血流动力学,采用一种改良的心房调转手术.2014年1月到2016年3月,7例患儿完成此种改良双调转手术的解剖矫治.5例合并肺动脉闭锁患儿施行了Rastelli-心房调转手术,2例施行了动脉-心房双调转手术.心房调转使用半Mustard手术占同期解剖矫治术中的26.9%(7/26).结果 全组无近期死亡.随访7~21个月,无死亡,无心房板障相关的再次手术或窦房结功能不全.术后三尖瓣反流轻至中度6例,中度1例.右心室-肺动脉管道无明显梗阻.结论 改良心房调转手术完成双调转手术初期结果良好.半Mustard和双向Glenn手术的减少板障及窦房结相关的并发症,手术方法相对简单,能改善右心功能和预后.
更多Objective To avoid complications associated with the complete Senning procedures and to assist right-heart hemodynamics, this study was undertaken to assess the risks and benefits of the double-switch operation using a hemi-Mustard atrial switch procedure and the bidirectional Glenn operation for congenitally corrected transposition of the great arteries. we fa-vor a modified atrial switch procedure. Methods Between January 2014 and March 2016, anatomic repair was achieved in 26 patients. A hemi-Mustard procedure was the atrial switch procedure for 26. 9%(7/26). The Rastelli-atrial switch procedure was performed in 5 patients( RAS) and the arterial-atrial switch procedure was performed in 2 patients( AAS) . Results There was no in-hospital death after anatomic repair. There were no late deaths in a median follow-up of 7-21 months. Glenn opera-tion complications were uncommon limited to the perioperative period, atrial baffle-related reoperations or sinus node dysfunc-tion had not been observed. Tricuspid regurgitation decreased to mild for 1 case and mild to moderate for 6 cases. Right ventri-cle-pulmonary artery conduit longevity was significantly improved. Conclusion We recentely describe an experience with the double-switch operation using a modified atrial switch procedure with favorable earlyterm results. The risks of the hemi-mustard and bidirectional Glenn operation are minimal and are limited to a well-defined patient subset. The benefits include reduced baffle-and sinus node-related complications, technical simplicity and inspiring results.
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