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目的探讨解剖纠治完全性大血管错位(TGA)伴肺动脉瓣狭窄的手术方法。方法1例8月龄、体重6.5kg的TGA伴肺动脉瓣狭窄男病婴,术中将原主动脉瓣移植至肺动脉瓣处形成新的主动脉;再行Switch术,同种带瓣管道连接右心室与肺动脉。另1例10月龄、体重9.8kg的该病男病婴,术中将整个主动脉瓣取下,保留左、右冠状动脉,向后移植,后半部分直接与原肺动脉瓣环连续缝合,前半部分与室间隔缺损之间采用dacron补片连续缝合关闭;肺动脉与右心室切口直接连接。结果2例手术均取得成功。出院时超声检查各吻合口通畅,无残余分流,无主动脉瓣反流。术后随访12个月和6个月,生长发育良好,心胸比率0.75。超声示左心功能良好,前例示主动脉瓣轻度反流,后例左、右心室流出道无残余梗阻。结论采用自体主动脉瓣移植纠治完全性大血管错位伴肺动脉瓣和瓣下狭窄,从解剖上得到彻底纠治,效果良好。由于病例少,随访时间短,还需进一步观察。
Objective To investigate the surgical method of dissecting and correcting complete large vessel dislocation (TGA) with pulmonary valve stenosis. Methods One case of 8-month-old TGA with pulmonary artery stenosis of 6 months old with a weight of 6.5kg was transplanted to the aortic valve from the aortic valve to form a new aorta. After the switch, the same kind of valved catheter was connected to the right ventricle With pulmonary artery. The other 1 case of 10-month-old, weighing 9.8kg of the disease male sick baby, the surgery will be the entire aortic valve removed, left and right coronary artery retained, backward transplantation, the latter part of the direct and original pulmonary valve ring suture, Between the first half and ventricular septal defect using dacron patch continuous suture closure; pulmonary artery and right ventricular incision directly connected. Results 2 cases of surgery were successful. Discharged ultrasound examination of anastomotic patency, no residual shunt, no aortic regurgitation. The patients were followed up for 12 months and 6 months, with good growth and development, with a cardiothoracic ratio of 0.75. Ultrasonography showed a good left heart function, the former case showed mild aortic regurgitation, after the cases of left and right ventricular outflow tract without residual obstruction. Conclusion Autologous aortic valve transplantation for the treatment of complete dislocation of the great vessels with pulmonary valve and subvalvular stenosis, obtained from the anatomy of complete correction, the effect is good. Due to fewer cases, follow-up time is short, need further observation.