摘 要：目的报道应用动脉转位术（ASO）治疗完全性大动脉错位（TGA）术后超声心动图的随访结果,评价TGA术后主、肺动脉的发育情况.方法以2001年3月至2007年3月于复旦大学附属儿科医院心血管中心实施ASO治疗TGA术后存活患儿作为研究对象,于2008年8～9月进行随访,行超声心动图检查,测定新主动脉根部内径、新主动脉瓣环内径、新肺动脉内径和新肺动脉瓣环内径,获取的数据与正常参考值做比较.结果研究期间ASO治疗TGA患儿共72例,术中死亡6/72例（8.3%）,存活率为91.7%.失访10/66例,有效数据56例,其中室间隔完整的完全性TGA（TGA/IVS）32例,完全性TGA合并室间隔缺损（TGA/VSD）24例.随访距手术18～168（86.46±23.51）个月.新主动脉根部内径为（16.97±2.71）mm（t=6.936,P<0.001）,12/56例（21.4%）>正常参考值90%CI的上限,44/56例（78.6%）在正常参考值90%CI内,平均Z值为1.10±0.70.新主动脉瓣环内径为（16.27±2.38）mm（t=4.52,P<0.001）,56例均在正常参考值90%CI内,平均Z值为0.66±0.65.新肺动脉内径为（14.29±1.92）mm（t=-3.2,P=0.005）,40/56例（71.4%）在正常参考值90%CI内,16/56例（28.6%）<正常参考值90%CI的下限,平均Z值为-0.95±1.33.新肺动脉瓣环内径为（14.00±1.92）mm（t=0.132,P=0.897）,42/56例（75.0%）在正常参考值90%CI内,14/56例（25.0%）<正常参考值90%CI的下限,平均Z值为0.05±1.85.16/56例（28.6%）存有主动脉瓣轻度反流,均为TGA/VSD病例,平均随访（46.0±22.2）个月;40/56例（71.4%）未见主动脉瓣反流,平均随访（46.8±25.3）个月,两组随访时间差异无统计学意义（P=0.899）.随访中未见主动脉狭窄病例.肺动脉瓣上狭窄7/56例（12.5%）,2/56例（3.6%）为轻度狭窄,5/56例（8.9%）为极轻度狭窄.结论目前在复旦大学附属儿科医院心血管中心开展ASO治疗TGA术后新主动脉根部和瓣环内径均有所扩张,新肺动脉根部内径有所缩减,但其瓣环发育良好.主动脉瓣反流常见于TGA/VSD病例,但其反流程度较轻.肺动脉瓣上狭窄是TGA术后常见的并发症,但大多数病例狭窄程度极轻.
关键词：完全性大动脉错位;动脉转位术;超声心动图;随访
Mid-termfollow-upoutcomeoftheneo-aortaandneo-pulmonaryarteryinpatientsafterarterialswitchoperationfortranspositionofthegreatarteries
SUNYong TANWei-qiang JIABing HUANGGuo-ying
作者简介：贾兵,E-mail:jiabing26@hotmail.com通讯作者
作者单位：孙勇（中国海洋大学附属医院心血管中心,青岛,266071）
谈卫强（复旦大学附属儿科医院心血管中心,上海,201102）
贾兵（复旦大学附属儿科医院心血管中心,上海,201102）
黄国英（复旦大学附属儿科医院心血管中心,上海,201102）
参考文献：
[1]JateneAD,FontesVF,PaulistaPP,etal.Successfulanatomiccorrectionoftranspositionofthegreatvessels.Apreliminaryreport.ArqBrasCardiol,1975,28（4）:461-464
[2]LecompteY,ZanniniL,HazanE,etal.Anatomiccorrectionoftranspositionofthegreatarteries.JThoracCardiovascSurg,1981,82（4）:629-631
[3]CastanedaAR,NorwoodWI,JonasRA,etal.Transpositionofthegreatarteriesandintactventricularseptum:anatomicalrepairintheneonate.AnnThoracSurg,1984,38（5）:438-443
[4]QuaegebeurJM,RohmerJ,OttenkampJ,etal.Thearterialswitchoperation.Aneight-yearexperience.JThoracCardiovascSurg,1986,92（3Pt1）:361-384
[5]XuZW（徐志伟）,XingWH,LiuJF,etal.Investigationofriskfactorsinfluencingthemortalityofthearterialswitchoperation.ChineseJournalofClinicalThoracicandCardiovascularSurgery（中国胸心血管外科临床杂志）,2006,13（3）:141-144
[6]DingWX（丁文祥）,SuZK.大动脉转位术治疗婴儿大动脉错位.ChineseJournalofThoracicandCardiovascularSurgery（中华胸心血管外科杂志）,1992,8（2）:78-79
[7]SunY（孙勇）,JiaB,MaXJ,etal.Mid-termfollow-upoutcomeofleftventriclefunctionandsizeofthegreatarteriesinpatientsafterarterialswitchoperation.ChineseJournalofPracticalPediatrics（中国实用儿科杂志）,2005,20（8）:479-481
[8]RammosS,KramerHH,TrampischHJ,etal.Normalvaluesofthegrowthofthepulmonaryarteriesinchildren.Anangiographystudy.Herz,1989,14（6）:348-357
[9]WilliamsWG,QuaegebeurJM,KirklinJW,etal.Outflowobstructionafterthearterialswitchoperation:amultiinstitutionalstudy.JThoracCardiovascSurg,1997,114（3）:975-979
[10]HraskaV,DuncanBW,MayerJEJr,etal.Long-termoutcomeofsurgicallytreatedpatientswithcorrectedtranspositionofthegreatarteries.JThoracCardiovascSurg,2005,129（1）:182-191
[11]PoirierNC,YuJH,BrizardCP,etal.Long-termresultsofleftventricularreconditioningandanatomiccorrectionforsystemicrightventriculardysfunctionafteratrialswitchprocedures.JThoracCardiovascSurg,2004,127（4）:975-981
[12]BrownJW,ParkHJ,TurrentineMW.Arterialswitchoperation:factorsimpactingsurvivalinthecurrentera.AnnThoracSurg,2001,71（6）:1978-1984
[13]McMahonCJ,GauvreauK,EdwardsJC,etal.Riskfactorsforaorticvalvedysfunctioninchildrenwithdiscretesubvalvaraorticstenosis.AmJCardiol,2004,94（4）:459-464
[14]HourihanM,ColanSD,WernovskyG,etal.Growthoftheaorticanastomosis,annulus,androotafterthearterialswitchprocedureperformedininfancy.Circulation,1993,88（2）:615-620
[15]SchwartzML,GauvreauK,delNidoP,etal.Long-termpredictorsofaorticrootdilationandaorticregurgitationafterarterialswitchoperation.Circulation,2004,110（11S1）:128-132
[16]CohenMS,MarinoBS,McElhinneyDB,etal.Neo-aorticrootdilationandvalveregurgitationupto21yearsafterstagedreconstructionforhypoplasticleftheartsyndrome.JAmCollCardiol,2003,42（3）:533-540
[17]PriftiE,CruceanA,BonacchiM,etal.Earlyandlongtermoutcomeofthearterialswitchoperationfortranspositionofthegreatarteries:predictorsandfunctionalevaluation.EurJCardiothoracSurg,2002,22（6）:864-873
[18]MussattoK,WernovskyG.Challengesfacingthechild,adolescent,andyoungadultafterthearterialswitchoperation.CardiolYoung,2005,15（S1）:111-121
A:
A:
