摘要
目的 通过超声心动图对 1 7例新生儿ASO术前的回顾 ,评价左室血流动力学的改变和冠状动脉解剖类型的正确诊断在新生儿单纯完全性大血管转位 (TGA)一期动脉转位术前的价值。方法 ①通过超声心动图对 1 7例新生儿TGA术前的左室形态分成 3组 :满意、可接受和不满意组 ,并对这 3组患儿的手术效果进行对比 ;②新生儿的年龄对左室形态的影响 ;③超声心动图对 1 0例“满意”的左室形态患儿冠状动脉解剖类型进行诊断 ,与术中直视下观察冠状动脉走向进行对比。结果 ①满意、可接受和不满意 3组患儿分别为 1 0、6和 1例 ,年龄分别为 1 0d内、1 0～ 2 0d和 2 0d以后 ;死亡率分别为 :30 %、83%和 1 0 0 %。②不典型冠状动脉发生率为 2 0 %,全部患儿均因移植后易发生扭曲、梗阻 ,导致死亡。结论 ①单纯TGA患儿应在新生儿的 1 0d内行一期ASO手术 ;②超声心动图正确地诊断冠状动脉解剖类型尤为重要 ,必要时行升主动脉造影 ,明确冠状动脉解剖类型。
Objectives To evaluate LV hemodynamic alteration and coronary artery anatomy patterns before arterial switch operation (ASO) for transposition of the great arteries (TGA) with intact ventricular septum (IVS) by echocardiography in 17 infants. Methods ①LV geometry was classified as “favorable”,“acceptable”or“unfavorable”before ASO for TGA with IVS by echocardiography and contrasted with surgical outcome. ②The relationship between age of infants and LV geometry was analyzed. ③we identificated coronary arterial anatomy by preoperative echocargiography in 10 infants of“favorable” LV geometry and compared it with the anatomy described at the time of the operation. Results ①17 infants of TGA were divided into three groups. The group of“favorable” LV geometry with 10 infants were less to 10 days old,the group of“acceptable”LV geometry with 6 infants were 10 to 20 days old and the group of“unfavorable” LV geometry with one infant was more than 20 days old. the operative mortality of three groups were 30%,83%and 100%. ②The incidence rate of atypical coronary artery anatomy was 20%,it was easy to obstruction by twisting after atypical coronary artery was planted,so these infants were caused to death. Conclusions ①The age limit for primary ASO in infants with TGA/IVS should be with in the first 10 days old. ②Preoperative diagnosis of the coronary artery pattern in TGA by echocardiography is important because deviation from the usual pattern may influence the surgical strategy. angiography must be performed in cases in which the coronary artery anatomy is not clearly demonstrated by echocardiography.
出处
《岭南心血管病杂志》
2004年第5期318-320,350,共4页
South China Journal of Cardiovascular Diseases
