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目的:观察完全性大动脉转位(D-TGA)患者快速二期大动脉调转术(ASO)中左心室血流动力学变化,评价肺动脉环缩对左心室的影响。方法:15例室间隔完整或合并小型室间隔缺损的D-TGA患者,应用多普勒超声心动图观察快速二期ASO手术前、后左心室舒张期直径(LVDD)、舒张期左心室后壁厚度(LVPWT)、舒张期室间隔厚度(IVST)的变化,计算左心室质量及射血分数。结果:15例均行肺动脉环缩及体肺分流术,13例在肺动脉环缩后10±3.5天行ASO。肺动脉环缩后左、右心室压力比从0.42±0.18上升至0.83±0.08,左心室质量指数从29.0±10.6g/m2上升至69.6±18.6g/m2(P<0.01),平均每天上升4.06g/m2。肺动脉环缩后左心室射血分数从75.3%±15.4%下降至51.9%±19.2%(P<0.05),大约3~4天后恢复正常(65.7%±5.1%)。结论:肺动脉环扎后,左室质量明显增加;左心功能明显下降,但可迅速恢复正常;快速二期大动脉调转术对大年龄室间隔完整或合并小型室间隔缺损的D-TGA患者是可行的。
Objective: To observe the changes of left ventricular hemodynamics in patients with complete aortic transposition (D-TGA) undergoing rapid second-stage aortic regurgitation (ASO) and evaluate the effect of pulmonary constriction on the left ventricle. Methods: Doppler echocardiography was used to observe the left ventricular diastolic diameter (LVDD), diastolic left ventricular posterior wall (LVDD) in 15 cases of D-TGA patients with intact ventricular septum or small ventricular septal defect. Thickness (LVPWT) and diastolic interventricular septum thickness (IVST) were measured to calculate left ventricular mass and ejection fraction. Results: In all 15 cases, pulmonary vasoconstriction and shunting were performed. Thirteen cases underwent ASO at 10 ± 3.5 days after pulmonary vasoconstriction. The left and right ventricular systolic pressure increased from 0.42 ± 0.18 to 0.83 ± 0.08 and the left ventricular mass index increased from 29.0 ± 10.6g / m2 to 69.6 ± 18.6g / m2 (P <0.01) after ring contraction, respectively, with an average daily increase of 4.06g / m2. Left ventricular ejection fraction of pulmonary arteries decreased from 75.3% ± 15.4% to 51.9% ± 19.2% (P <0.05), and returned to normal after about 3 to 4 days (65.7% ± 5.1%). Conclusions: Left ventricular mass increased significantly after pulmonary artery occlusion, and left ventricular function decreased significantly, but returned to normal quickly. Rapid second phase aortic transposition is feasible for D-TGA patients with intact or small ventricular septal defect in large age group. of.