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目的探讨肺动脉环缩术在矫正型大动脉转位形态学左心室功能锻炼的临床应用效果。方法回顾性分析2007年1月至2011年12月上海交通大学医学院附属上海儿童医学中心手术治疗矫正型大动脉转位患者89例中行肺动脉环缩术11例的临床资料,其中男9例,女2例;年龄除1例12岁外,其余为3～42(16.40±11.67)个月;体重6～32(11.70±7.20)kg。所有患者均经超声心动图和心血管造影检查确诊。结果 11例行肺动脉环缩术患者无死亡,术前肺循环与体循环压力比(Pp/Ps)值0.3～0.6(0.44±0.09),术后为0.6～0.8(0.70±0.04),差异有统计学意义(P<0.01)。术前三尖瓣反流轻度2例(18.2%),中度5例(45.4%),重度4例(36.4%);术后无反流2例(18.2%),轻度反流7例(63.6%),轻-中度反流2例(18.2%)。11例中5例术后(15.20±8.31)个月行二期双心室解剖纠治术,其中1例死亡;余6例行单纯肺动脉环缩术后随访(18.83±3.43)个月,超声心动图检查提示:三尖瓣反流轻微2例(33.3%),轻度3例(50.0%),中度1例(16.7%)。结论矫正型大动脉转位通过肺动脉环缩术可减轻三尖瓣反流,锻炼形态学左心室功能,为二期解剖纠治做好准备,手术效果较好。但术后必须定期随访,观察术后形态学左心室功能和三尖瓣反流情况。
Objective To investigate the clinical effect of pulmonary arterial ring reduction on left ventricular functional exercise in transposition of aorta. Methods A retrospective analysis of clinical data of 89 cases of pulmonary artery ring reduction in 89 cases of surgical correction of aortic transposition in Shanghai Children’s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine from January 2007 to December 2011 was retrospectively reviewed. Among them, 9 males and 8 females 2 cases; the age except 1 case of 12 years old, the rest was 3 ~ 42 (16.40 ± 11.67) months; body weight 6 ~ 32 (11.70 ± 7.20) kg. All patients were confirmed by echocardiography and cardiovascular angiography. Results There were no deaths in 11 cases of pulmonary arterial ring reduction. The preoperative pulmonary and systemic pressure ratio (Pp / Ps) were 0.3-0.6 (0.44 ± 0.09) and 0.6-0.8 (0.70 ± 0.04) respectively, the difference was statistically significant Significance (P <0.01). Preoperative tricuspid regurgitation was mild in 2 cases (18.2%), moderate in 5 cases (45.4%) and severe in 4 cases (36.4%). No postoperative reflux occurred in 2 cases (18.2%), mild reflux Cases (63.6%), mild to moderate reflux in 2 cases (18.2%). Five of the 11 patients underwent postoperative bi-ventricular anatomical repair (15.20 ± 8.31) months, of which 1 died. The remaining 6 patients were followed up for 18.83 ± 3.43 months after simple pulmonary embolization. Echocardiography Figure examination Tip: Tricuspid regurgitation in 2 cases (33.3%), mild in 3 cases (50.0%), moderate in 1 case (16.7%). Conclusion Corrected aortic transposition through the pulmonary artery systole can reduce the tricuspid regurgitation, exercise morphological left ventricular function, to prepare for the second stage dissection, the operation is better. But after surgery must be followed up regularly to observe postoperative morphology of left ventricular function and tricuspid regurgitation.