[Temporary use of left ventricle-to-pulmonary artery extracardiac conduit for the surgical repair of complete transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction].
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引用次数: 0
Abstract
A 1.8-year-old boy was first admitted to our hospital at 12 days of age with the diagnosis of transposition of the great arteries (TGA), ventricular septal defect (VSD), and left ventricular outflow tract obstruction (LVOTO). Echocardiography and catheter examination at 10 months of age disclosed severe organic stenosis of left ventricular outflow tract (LVOT) with its diameter of 5.6 mm (50% of N) and the left to right ventricular (LV/RV) pressure ratio of 0.6. At 1.8 years of age, he underwent complete correction which comprised intraatrial switch (Senning procedure), direct closure of VSD, and removal of thickened endocardium at LVOT. Because of the residual LVOTO, evidenced by postoperative LV/RV pressure ratio of 1.4, placement of 14 mm PTFE graft extracardiac conduit was concomitantly performed. The conduit from the left ventricular apex to the main pulmonary artery effectively lowered the left ventricular pressure with LV/RV pressure ratio of 0.68. Repeat catheter examination at 2.10 years of age revealed further descent of LV/RV pressure ratio to 0.32. Based on the findings that balloon occlusion of the conduit elicited only a minimal elevation of the left ventricular pressure (from 30 to 34 mmHg), the conduit was removed at 3.6 years of age. The third catheter examination at the age of 3.9 years confirmed LV/RV pressure ratio of 0.43. The patient is leading a normal life. without medication 3 years after the operation. This experience draws us to conclude that placement of left ventricle-to-pulmonary artery conduit concomitantly with the intraatrial switch is a useful adjunctive procedure for the complete correction of TGA, small VSD, and LVOTO, and that, in a subset of the patients, this procedure may allow amelioration of LVOTO and secondary removal of the conduit.
一名1.8岁男孩于12天大时首次入住我院,诊断为大动脉转位(TGA)、室间隔缺损(VSD)和左心室流出道梗阻(LVOTO)。10月龄超声心动图及导管检查显示左室流出道器质性狭窄严重,直径5.6 mm (50% N),左右心室(LV/RV)压比0.6。在1.8岁时,他接受了完整的矫正,包括心房开关(Senning手术),直接关闭VSD,并在LVOT切除增厚的心内膜。由于LVOTO残留,术后左室/右室压力比为1.4,因此同时放置14mm聚四氟乙烯移植物心外导管。左室心尖至肺动脉主干的导管有效降低左室压力,左室/右室压力比为0.68。2.10岁时复查导管显示左室/右室压比进一步下降至0.32。基于球囊阻塞导管仅引起左心室压力轻微升高(从30至34 mmHg)的发现,在3.6岁时切除导管。3.9岁时第三次行导管检查,确认左室/右室压比为0.43。病人过着正常的生活。术后3年未用药。这一经验使我们得出结论,左心室到肺动脉导管与心房开关的放置是一种有用的辅助手术,可以完全纠正TGA,小VSD和LVOTO,并且,在一部分患者中,该手术可以改善LVOTO和二次切除导管。