矯正型大動脈轉位形態三尖瓣“瓣中瓣置換術及早中期結果_《中國胸心血管外科臨床雜志》

作者：

魏宇 , 許建屏

北京協和醫學院中國醫學科學院阜外心血管病醫院外科，北京 100037;

關鍵詞：

矯正型大動脈轉位瓣中瓣形態三尖瓣置換術

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目的　探討矯正型大動脈轉位（ cTGA）患者行形態三尖瓣“瓣中瓣”法置換術的方法及其術后早中期療效。方法　自 2009年 1月至 2012年 1月期間，阜外心血管病醫院收治 11例 cTGA患者，其中男 9例，女 2例；年齡（37.8±11.7）歲；體重（ 73.0±11.3）kg。均采用保留全瓣及瓣下結構即“瓣中瓣”法行形態三尖瓣置換術，同期行室間隔缺損修補術 2例，房間隔缺損修補術 4例，肺動脈瓣成形術 1例，功能右心室流出道疏通術 4例，冠狀動脈肺動脈瘺修補術 1例。術后隨訪患者紐約心臟學會（NYHA）心功能分級、心胸比率、形態右心室的射血分數及其舒張期末內徑、形態左心房舒張期末內徑。結果　11例患者均生存并得到隨訪，隨訪（13.0±10.6）個月。術后隨訪時心胸比率與術前比較差異無統計學意義（ 0.54±0.06 vs. 0.57±0.09，t =1.581，P＞0.05），形態右心室射血分數與術前比較差異無統計學意義（ 52.8%±9.0% vs. 54.9%±9.5%，t = 0.712，P＞0.05），形態右心室舒張期末內徑與術前比較差異無統計學意義［（54.3±7.5）mm vs.（56.9±9.2）mm，t =0.988，P＞0.05］，形態左心房舒張期末內徑與術前比較差異有統計學意義［（42.1±8.9）mm vs.（53.4±11.1）mm，t =3.286，P＜0.05］，術后心功能分級較術前比較差異有統計學意義（ Z = -2.640，P＜0.05）。結論　cTGA形態三尖瓣“瓣中瓣”置換術保留了形態右心室的幾何結構形態，阻止了形態三尖瓣關閉不全對形態右心室功能的進一步損害；形態左心房功能及心功能分級明顯改善；術后早中期結果滿意。

引用本文： 魏宇,許建屏. 矯正型大動脈轉位形態三尖瓣“瓣中瓣置換術及早中期結果. 中國胸心血管外科臨床雜志, 2012, 19(3): 235-239. doi: 復制

1.	Cardiovasc Surg, 2004, 127 （4）：975-981.
2.	Connelly MS, Liu PP, Williams WG, et al. Congenitally corrected transposition of the great arteries in the adult：functional status and complications. J Am Coll Cardiol, 1996, 27 （5）：1238-1243.
3.	Van Praagh R, Papagiannis J, Grünenfelder J, et al. Pathologic anatomy of corrected transposition of the great arteries：medical and surgical implications. Am Heart J, 1998, 135 （5 Pt 1）：772-785.
4.	Ergenoglu MU, Yerebakan H, Ozveren O, et al. Prosthetic valve implantation with preservation of the entire valvular and subvalvular apparatus of the tricuspid valve in congenitally corrected transposition of the great arteries. Heart Surg Forum, 2011, 14 （5）：E326-327.
5.	Kuehl KS, Loffredo CA. Population-based study of l-transposition of the great arteries：possible associations with environmental factors. Birth Defects Res A Clin Mol Teratol, 2003, 67 （3）：162-167.
6.	Huhta JC, Maloney JD, Ritter DG, et al. Complete atrioventricular block in patients with atrioventricular discordance. Circulation, 1983, 67 （6）：1374-1377.
7.	Ohuchi H, Hiraumi Y, Tasato H, et al. Comparison of the right and left ventricle as a systemic ventricle during exercise in patients with congenital heart disease. Am Heart J, 1999, 137 （6）：1185-1194.
8.	Isaacson R, Titus JL, Merideth J, et al. Apparent interruption of atrial conduction pathways after surgical repair of transposition of great arteries. Am J Cardiol, 1972, 30 （5）：533-535.
9.	Ikeda U, Furuse M, Suzuki O, et al. Long-term survival in aged patients with corrected transposition of the great arteries. Chest, 1992, 101 （5）：1382-1385.
10.	Prieto LR, Hordof AJ, Secic M, et al. Progressive tricuspid valve disease in patients with congenitally corrected transposition of the great arteries. Circulation, 1998, 98 （10）：997-1005.
11.	Westerman GR, Lang P, Castaneda AR, et al. Corrected transposition and repair of associated intracardiac defects. Circulation, 1982, 66 （2 Pt 2）：I197-202.
12.	Sano T, Riesenfeld T, Karl TR, et al. Intermediate-term outcome after intracardiac repair of associated cardiac defects in patients with atrioventricular and ventriculoarterial discordance. Circulation, 1995, 92 （9 Suppl）：II272-278.
13.	Van Son JA, Danielson GK, Huhta JC, et al. Late results of systemic atrioventricular valve replacement in corrected transposition. J Thorac Cardiovasc Surg, 1995, 109 （4）：642-652.
14.	Graham TP, Jr Bernard YD, Mellen BG, et al. Long-term outcome in congenitally corrected transposition of the great arteries：a multi-institutional study. J Am Coll Cardiol, 2000, 36 （1）：255-261.
15.	Voskuil M, Hazekamp MG, Kroft LJ, et al. Postsurgical course of patients with congenitally corrected transposition of the great arteries. Am J Cardiol, 1999, 83 （4）：558-562.
16.	Graham TP Jr, Parrish MD, Boucek RJ Jr, et al. Assessment of ventricular size and function in congenitally corrected transposition of the great arteries. Am J Cardiol, 1983, 51 （2）：244-251.
17.	Hauser M, Bengel FM, Hager A, et al. Impaired myocardial blood flow and coronary flow reserve of the anatomical right systemic ventricle in patients with congenitally corrected transposition of the great arteries. Heart, 2003, 89 （10）：1231-1235.
18.	Dodge-Khatami A, Tulevski, Ii, Bennink GB, et al. Comparable systemic ventricular function in healthy adults and patients with unoperated congenitally corrected transposition using MRI dobutamine stress testing. Ann Thorac Surg, 2002, 73 （6）：1759-1764.
19.	Kharge J, Prasad MR, Ramegowda RT. An unusual case of congenitally corrected transposition of the great arteries associated with noncompaction-like remodeling of the morphological right ventricle. Echocardiography, 2011, 28 （10）：E212-214.
20.	Termignon JL, Leca F, Vouhe PR, et al. “Classic” repair of congenitally corrected transposition and ventricular septal defect. Ann Thorac Surg, 1996, 62 （1）：199-206.
21.	Shin’oka T, Kurosawa H, Imai Y, et al. Outcomes of definitive surgical repair for congenitally corrected transposition of the great arteries or double outlet right ventricle with discordant atrioventricular connections：risk analyses in 189 patients. J Thorac Cardiovasc Surg, 2007, 133 （5）：1318-1328.
22.	Ilbawi MN, Ocampo CB, Allen BS, et al. Intermediate results of the anatomic repair for congenitally corrected transposition. Ann Thorac Surg, 2002, 73 （2）：594-599.
23.	花中東, 胡盛壽, 潘湘斌, 等. 107例矯正型大動脈轉位手術治療中期結果分析. 中國循環雜志, 2009, 24 （3）：221-223.
24.	夏明鈺, 王浩, 葉贊凱, 等. 經胸超聲心動圖評價先天性矯正型大動脈轉位合并其它心內畸形的外科治療效果. 中國超聲醫學雜志, 2008, 24 （11）：1036-1039.
25.	朱洪玉, 汪曾煒, 方敏華, 等. 雙調轉術治療矯正型大動脈轉位合并心內畸形. 中華胸心血管外科雜志, 2005, 21 （5）：260-262.
26.	Devaney EJ, Charpie JR, Ohye RG, et al. Combined arterial switch and Senning operation for congenitally corrected transposition of the great arteries：patient selection and intermediate results. J Thorac Cardiovasc Surg, 2003, 125(3）：500-507.
27.	Duncan BW, Mee RB. Management of the failing systemic right ventricle. Semin Thorac Cardiovasc Surg, 2005, 17 （2）：160-169.
28.	Mee RB. Severe right ventricular failure after Mustard or Senning operation. Two-stage repair：pulmonary artery banding and switch. J Thorac Cardiovasc Surg, 1986, 92 （3 Pt 1）：385-390.
29.	Poirier NC, Yu JH, Brizard CP, et al. Long-term results of left ventricular reconditioning and anatomic correction for systemic right ventricular dysfunction after atrial switch procedures. J Thorac.
30.	Quinn DW, Mcguirk SP, Metha C, et al. The morphologic left ventricle that requires training by means of pulmonary artery banding before the double-switch procedure for congenitally corrected transposition of the great arteries is at risk of late dysfunction. J Thorac Cardiovasc Surg, 2008, 135 （5）：1137-1144.
31.	Scherptong RW, Vliegen HW, Winter MM, et al. Tricuspid valve surgery in adults with a dysfunctional systemic right ventricle：repair or replace? Circulation, 2009, 119 （11）：1467-1472.
32.	羅國華, 胡盛壽, 孫寒松, 等. 矯正型大動脈轉位形態三尖瓣置換術及中遠期結果. 中國胸心血管外科臨床雜志, 2009, 16 （5）：333-335.
33.	Lundstrom U, Bull C, Wyse RK, et al. The natural and "unnatural" history of congenitally corrected transposition. Am J Cardiol, 1990, 65 （18）：1222-1229.
34.	Mongeon FP, Connolly HM, Dearani JA, et al. Congenitally corrected transposition of the great arteries ventricular function at the time of systemic atrioventricular valve replacement predicts long-term ventricular function. J Am Coll Cardiol, 2011, 57 （20）：2008-2017.
35.	劉鋒, 龔光甫, 熊煉 . “瓣中瓣”法二尖瓣置換術21例. 中國胸心血管外科臨床雜志, 2006, 13 （2）：122-123.
36.	Straub U, Feindt P, Huwer H, et al. Postoperative assessment of chordal preservation and changes in cardiac geometry following mitral valve replacement. Eur J Cardiothorac Surg , 1996, 10 （9）：734-740.
37.	Lorenz CH, Walker ES, Graham TP Jr, et al. Right ventricular performance and mass by use of cine MRI late after atrial repair of transposition of the great arteries. Circulation, 1995, 92 （9 Suppl）：II 233-239.

1. Cardiovasc Surg, 2004, 127 （4）：975-981.
2. 　Connelly MS, Liu PP, Williams WG, et al. Congenitally corrected transposition of the great arteries in the adult：functional status and complications. J Am Coll Cardiol, 1996, 27 （5）：1238-1243.
3. 　Van Praagh R, Papagiannis J, Grünenfelder J, et al. Pathologic anatomy of corrected transposition of the great arteries：medical and surgical implications. Am Heart J, 1998, 135 （5 Pt 1）：772-785.
4. 　Ergenoglu MU, Yerebakan H, Ozveren O, et al. Prosthetic valve implantation with preservation of the entire valvular and subvalvular apparatus of the tricuspid valve in congenitally corrected transposition of the great arteries. Heart Surg Forum, 2011, 14 （5）：E326-327.
5. 　Kuehl KS, Loffredo CA. Population-based study of l-transposition of the great arteries：possible associations with environmental factors. Birth Defects Res A Clin Mol Teratol, 2003, 67 （3）：162-167.
6. 　Huhta JC, Maloney JD, Ritter DG, et al. Complete atrioventricular block in patients with atrioventricular discordance. Circulation, 1983, 67 （6）：1374-1377.
7. 　Ohuchi H, Hiraumi Y, Tasato H, et al. Comparison of the right and left ventricle as a systemic ventricle during exercise in patients with congenital heart disease. Am Heart J, 1999, 137 （6）：1185-1194.
8. 　Isaacson R, Titus JL, Merideth J, et al. Apparent interruption of atrial conduction pathways after surgical repair of transposition of great arteries. Am J Cardiol, 1972, 30 （5）：533-535.
9. 　Ikeda U, Furuse M, Suzuki O, et al. Long-term survival in aged patients with corrected transposition of the great arteries. Chest, 1992, 101 （5）：1382-1385.
10. 　Prieto LR, Hordof AJ, Secic M, et al. Progressive tricuspid valve disease in patients with congenitally corrected transposition of the great arteries. Circulation, 1998, 98 （10）：997-1005.
11. 　Westerman GR, Lang P, Castaneda AR, et al. Corrected transposition and repair of associated intracardiac defects. Circulation, 1982, 66 （2 Pt 2）：I197-202.
12. 　Sano T, Riesenfeld T, Karl TR, et al. Intermediate-term outcome after intracardiac repair of associated cardiac defects in patients with atrioventricular and ventriculoarterial discordance. Circulation, 1995, 92 （9 Suppl）：II272-278.
13. 　Van Son JA, Danielson GK, Huhta JC, et al. Late results of systemic atrioventricular valve replacement in corrected transposition. J Thorac Cardiovasc Surg, 1995, 109 （4）：642-652.
14. 　Graham TP, Jr Bernard YD, Mellen BG, et al. Long-term outcome in congenitally corrected transposition of the great arteries：a multi-institutional study. J Am Coll Cardiol, 2000, 36 （1）：255-261.
15. 　Voskuil M, Hazekamp MG, Kroft LJ, et al. Postsurgical course of patients with congenitally corrected transposition of the great arteries. Am J Cardiol, 1999, 83 （4）：558-562.
16. 　Graham TP Jr, Parrish MD, Boucek RJ Jr, et al. Assessment of ventricular size and function in congenitally corrected transposition of the great arteries. Am J Cardiol, 1983, 51 （2）：244-251.
17. 　Hauser M, Bengel FM, Hager A, et al. Impaired myocardial blood flow and coronary flow reserve of the anatomical right systemic ventricle in patients with congenitally corrected transposition of the great arteries. Heart, 2003, 89 （10）：1231-1235.
18. 　Dodge-Khatami A, Tulevski, Ii, Bennink GB, et al. Comparable systemic ventricular function in healthy adults and patients with unoperated congenitally corrected transposition using MRI dobutamine stress testing. Ann Thorac Surg, 2002, 73 （6）：1759-1764.
19. 　Kharge J, Prasad MR, Ramegowda RT. An unusual case of congenitally corrected transposition of the great arteries associated with noncompaction-like remodeling of the morphological right ventricle. Echocardiography, 2011, 28 （10）：E212-214.
20. 　Termignon JL, Leca F, Vouhe PR, et al. “Classic” repair of congenitally corrected transposition and ventricular septal defect. Ann Thorac Surg, 1996, 62 （1）：199-206.
21. 　Shin’oka T, Kurosawa H, Imai Y, et al. Outcomes of definitive surgical repair for congenitally corrected transposition of the great arteries or double outlet right ventricle with discordant atrioventricular connections：risk analyses in 189 patients. J Thorac Cardiovasc Surg, 2007, 133 （5）：1318-1328.
22. 　Ilbawi MN, Ocampo CB, Allen BS, et al. Intermediate results of the anatomic repair for congenitally corrected transposition. Ann Thorac Surg, 2002, 73 （2）：594-599.
23. 　花中東, 胡盛壽, 潘湘斌, 等. 107例矯正型大動脈轉位手術治療中期結果分析. 中國循環雜志, 2009, 24 （3）：221-223.
24. 　夏明鈺, 王浩, 葉贊凱, 等. 經胸超聲心動圖評價先天性矯正型大動脈轉位合并其它心內畸形的外科治療效果. 中國超聲醫學雜志, 2008, 24 （11）：1036-1039.
25. 　朱洪玉, 汪曾煒, 方敏華, 等. 雙調轉術治療矯正型大動脈轉位合并心內畸形. 中華胸心血管外科雜志, 2005, 21 （5）：260-262.
26. 　Devaney EJ, Charpie JR, Ohye RG, et al. Combined arterial switch and Senning operation for congenitally corrected transposition of the great arteries：patient selection and intermediate results. J Thorac Cardiovasc Surg, 2003, 125(3）：500-507.
27. 　Duncan BW, Mee RB. Management of the failing systemic right ventricle. Semin Thorac Cardiovasc Surg, 2005, 17 （2）：160-169.
28. 　Mee RB. Severe right ventricular failure after Mustard or Senning operation. Two-stage repair：pulmonary artery banding and switch. J Thorac Cardiovasc Surg, 1986, 92 （3 Pt 1）：385-390.
29. 　Poirier NC, Yu JH, Brizard CP, et al. Long-term results of left ventricular reconditioning and anatomic correction for systemic right ventricular dysfunction after atrial switch procedures. J Thorac.
30. 　Quinn DW, Mcguirk SP, Metha C, et al. The morphologic left ventricle that requires training by means of pulmonary artery banding before the double-switch procedure for congenitally corrected transposition of the great arteries is at risk of late dysfunction. J Thorac Cardiovasc Surg, 2008, 135 （5）：1137-1144.
31. 　Scherptong RW, Vliegen HW, Winter MM, et al. Tricuspid valve surgery in adults with a dysfunctional systemic right ventricle：repair or replace? Circulation, 2009, 119 （11）：1467-1472.
32. 　羅國華, 胡盛壽, 孫寒松, 等. 矯正型大動脈轉位形態三尖瓣置換術及中遠期結果. 中國胸心血管外科臨床雜志, 2009, 16 （5）：333-335.
33. 　Lundstrom U, Bull C, Wyse RK, et al. The natural and "unnatural" history of congenitally corrected transposition. Am J Cardiol, 1990, 65 （18）：1222-1229.
34. 　Mongeon FP, Connolly HM, Dearani JA, et al. Congenitally corrected transposition of the great arteries ventricular function at the time of systemic atrioventricular valve replacement predicts long-term ventricular function. J Am Coll Cardiol, 2011, 57 （20）：2008-2017.
35. 　劉鋒, 龔光甫, 熊煉 . “瓣中瓣”法二尖瓣置換術21例. 中國胸心血管外科臨床雜志, 2006, 13 （2）：122-123.
36. 　Straub U, Feindt P, Huwer H, et al. Postoperative assessment of chordal preservation and changes in cardiac geometry following mitral valve replacement. Eur J Cardiothorac Surg , 1996, 10 （9）：734-740.
37. 　Lorenz CH, Walker ES, Graham TP Jr, et al. Right ventricular performance and mass by use of cine MRI late after atrial repair of transposition of the great arteries. Circulation, 1995, 92 （9 Suppl）：II 233-239.

《中國胸心血管外科臨床雜志》

矯正型大動脈轉位形態三尖瓣“瓣中瓣置換術及早中期結果

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《中國胸心血管外科臨床雜志》

矯正型大動脈轉位形態三尖瓣“瓣中瓣置換術及早中期結果

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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