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目的回顾性分析大动脉转换术的手术疗效。方法 2001年1月至2005年12月,采用大动脉转换术纠治完伞性大动脉错位113例,其中室间隔完整型大动脉错位(TGA/IVS)60例,伴室间隔缺损大动脉错位(TGA/VSD)53例。患儿体重最轻2.3 kg,年龄最小出生后6 h。在深低温停循环和低流量下行大动脉转换术。结果手术总死亡率9.7%,其中 TGA/IVS 死亡5例,手术死亡率8.3%,TGA/VSD 死亡6例,手术死亡率11.3%。随着手术方法的不断改进和围手术期以及体外循环转流技术的提高,其手术死亡率不断下降,从早期的手术死亡率16.6%降至目前的5.6%。结论冠状动脉畸形是导致大动脉转换术死亡的关键,TGA/VSD 的冠状动脉畸形发生率较 TGA/IVS 要高。主动脉和肺动脉的位置并不影响手术成功率。左心室与有心室压力比例<0.6时,不能行大动脉转换术,否则术后将出现严重左心室低心排。
Objective To retrospectively analyze the surgical effect of aortic transposition. Methods From January 2001 to December 2005, a total of 113 cases of dislocation of the umbilical artery were treated by transposition of the aorta, including 60 cases of TGA / IVS and 60 cases of TGA / VSD with ventricular septal defect ) 53 cases. The youngest child weighs 2.3 kg, the youngest 6 h after birth. Deep hypothermic circulatory arrest and low-flow descending aortic transplants. Results The total operation mortality was 9.7%, including 5 cases of TGA / IVS death, 8.3% of operation mortality, 6 cases of TGA / VSD death and 11.3% of operation mortality. With the continuous improvement of surgical methods and perioperative and extracorporeal circulation bypass techniques, the operating mortality rate has been declining, from an early surgical mortality rate of 16.6% to the current 5.6%. Conclusions Coronary artery deformity is the key factor leading to the death of aortic transfer. The incidence of coronary artery deformity in TGA / VSD is higher than that in TGA / IVS. The location of aorta and pulmonary artery does not affect the success rate of surgery. Left ventricular and ventricular pressure ratio <0.6, can not be aortic conversion surgery, or postoperative will appear severe left ventricular low cardiac output.