CAJ | 학술논문

目的分析56例大动脉调转术的冠状动脉解剖分型和早期手术效果的关系.方法 2010年5月至2013年9月,56例完全型大动脉转位合并其他畸形患儿接受手术治疗.男39例,女17例;出生后5天～ 126个月.其中室间隔完整型19例,伴室间隔缺损36例,右心室双出口伴肺动脉瓣下室间隔缺损1例.合并房间隔缺损33例(含卵圆孔未闭),动脉导管未闭26例,重度肺动脉高压20例,肺动脉瓣狭窄2例,主动脉弓缩窄1例.所有患儿均接受大动脉调转术,术中均探查冠状动脉并行冠状动脉移植术.结果冠状动脉Yacoub A型46例:术后30天内死亡4例;Yacoub B型5例,术后30天内死亡2例;Yacoub C型2例,其中1例术后当天因低心排血量综合征死亡;Yacoub D型1例和YacoubE型2例,术后30天均无死亡.结论常见的冠状动脉畸形行大动脉调转术早期死亡比例未增加,存在单冠畸形和壁内冠状动脉会增加大动脉调转手术的早期死亡比例.
목적 분석56례대동맥조전술적관상동맥해부분형화조기수술효과적관계.방법 2010년5월지2013년9월,56례완전형대동맥전위합병기타기형환인접수수술치료.남39례,녀17례;출생후5천～ 126개월.기중실간격완정형19례,반실간격결손36례,우심실쌍출구반폐동맥판하실간격결손1례.합병방간격결손33례(함란원공미폐),동맥도관미폐26례,중도폐동맥고압20례,폐동맥판협착2례,주동맥궁축착1례.소유환인균접수대동맥조전술,술중균탐사관상동맥병행관상동맥이식술.결과 관상동맥Yacoub A형46례:술후30천내사망4례;Yacoub B형5례,술후30천내사망2례;Yacoub C형2례,기중1례술후당천인저심배혈량종합정사망;Yacoub D형1례화YacoubE형2례,술후30천균무사망.결론 상견적관상동맥기형행대동맥조전술조기사망비례미증가,존재단관기형화벽내관상동맥회증가대동맥조전수술적조기사망비례.
Objective This study was designed to investigate the relationship of the coronary anatomy pattern in 56 arterial switch operation (ASO) with the early outcome.Methods From May 2010 to September 2013,a total of 56 patients with transposition of the great arteries complicated with other defomities(39 males and 17 females,with age of 5 days to 126 months),who were undertook ASO in Capital Medical University affiliated Beijing Anzhen Hospital.There were 19 patients with complete transposition of the great arteries and intact ventricular septum,35 patients with complete transposition of the great arteries and ventricular septal defect.and 1 patient with double outlet right ventricle with subpulmonary ventricular septal defect (Taussing-Bing).33 were complicated with atrial septal defect and 26 with patent ductus arteriosus,20 had severe pulmonary hypertension,2 had pumonic valve stenosis and 1 had coarctatioin of aorta.All patients undertook ASO,coronay distribution were detected during the procedure and coronary artery were grafed.Results Coronary artery:Yacoub type A were 46 cases:4 patients died during the 30 days after the operation,Yacoub type B were 5 cases:2 patients died.Yacoub type C were 2 cases:1 died of low cardiac output on the operating day.Yacoub type D were 1 case and Yacoub type E were 2 cases:none of them died.Conclusion Patients with common coronary variants have undergone ASO without added mortality rate.Those with intramural or single coronary arteries have significant added mortality rate.