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find Keyword "转位术" 20 results
  • 135例动脉转位术患者围手术期监护

    目的 总结动脉转位术(ASO)围手术期监护的经验,为提高其疗效提供借鉴。 方法 回顾性分析2000年1月至2009年6月广东省人民医院收治的135例完全型大动脉转位(TGA)患者行ASO的临床资料,男110例,女25例;手术时日龄1~160 d(27.24±26.49 d),体重2.4~5.0 kg(3.52±0.66 kg)。室间隔完整61例,室间隔缺损74例。术前动态监测血乳酸水平,纠正心功能不全,对98例(72.59%)明显低氧血症患者给予持续静脉注射前列腺素E1[PGE1,2~200 ng/(kg·min)]。手术在低温体外循环下施行,同期矫治合并畸形。术后严密监测凝血指标、左心功能,以间歇指令通气+容量保证通气(SIMV+VG)模式进行呼吸支持。22例术后应用PGE1[4~20 ng/(kg·min)]。 结果 全组体外循环时间36~423 min(189.20±59.94 min),主动脉阻断时间0~219 min(120.07±31.09 min),118例术后即时血氧饱和度95%~100%。术后机械通气时间24~792 h(168.24±154.80 h),总住院时间1~89 d(30.31±17.21 d)。生存108例,死亡27例(20.00%),主要死亡原因为低心排血量综合征。2001~2003年病死率为50.00%,2004~2006年为36.36%,2007~2009年后为8.43%,明显下降(χ2=18.323,Plt;0.001)。术后并发症:感染30例(22.22%),肺不张35例(25.93%);心电图检查示:STT改变50例(37.04%),心律失常44例(32.59%);超声心动图提示:吻合口狭窄36例(26.67%),肺动脉狭窄33例(24.44%)。 结论 ASO应用于TGA手术效果良好,除手术、麻醉操作外,术前维持内环境稳定、控制血乳酸水平,术后注意呼吸管理、维护左心功能是成功的关键。

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
  • Aortic Root Reconstruction with the Remaining Coronary Buttons in Arterial Switch Operation

    Objective To summarize the clinical experiences of using the remaining coronary buttons to reconstruct the neoaortic root in the arterial switch operation (ASO) and discuss the clinical significance of preserving the morphology of aortic sinus in improving postoperative coronary artery perfusion. Methods From January 2003 to June 2009, 110 patients with transposition of great arteries (TGA) combined with ventricular septal defect (VSD ) or the Taussig Bing anomaly treated in our hospital were enrolled in this study. The patients were at the age between 2 days and 2 years averaged 91.1 days, and their body weight varied between 1.79 and 9.50 kg with an average weight of 4.70 kg. The patients were divided into two groups based on different surgical strategies. For group A (n=78), we reconstructed the neoaortic root with the remaining coronary buttons by shortening the diameter of the proximal neoaorta. While for group B (n=32), we excised the remaining coronary buttons with the aortopulmonary diameter mismatched. The risk factors of hospital mortality were analyzed with stepwise logistic regression. Results Twelve patients died early after operation with a death rate of 10.9% (12/110). Mortality in group A was significantly lower than that in group B [6.4%(5/78) vs. 21.9%(7/32),P= 0.019]. Clinical followup was completed in 72 survivors with the followup time of 3 months to 5 years after operation. Late death occurred in 3 patients including 1 in group A and 2 in group B. Five patients underwent reoperations. Univariate logistic regression analysis showed that risk factors for early postoperative death were TaussigBing anomaly (χ2=4.011,P=0.046), aortic arch anomaly (χ2=4.437,P=0.036), single coronary artery pattern (χ2=5.071,P=0.025) and patients in group B (χ2=5.584, P= 0.019). Multivariate analysis confirmed that the aortic arch anomaly (χ2= 5.681, P=0.010 ) and patients in group B (χ2=3.987, P=0.047 ) were two independent risk factors for early mortality after operation. Conclusion The modified technique which uses the remaining coronary buttons to reconstruct the neoaortic root can preserve the morphology of neoaortic root better. The special anatomical morphology of aortic sinus has close relation to the perfusion of coronary arteries. The lowering hospital mortality may be due to the better perfusion of the coronary arteries.

    Release date:2016-08-30 06:02 Export PDF Favorites Scan
  • Risk Factors for Mortality in the Arterial Switch Operation

    Abstract: Objective To analyze risk factors for perioperative mortality in the arterial switch operation (ASO), in order to provide better operation and decrease the mortality rate. Methods We enrolled 208 ASO patients including 157 males and 51 females at Fu Wai Hospital between January 1, 2001 and December 31, 2007. The age ranged from 6 h to 17 years with the median age of 90 d and the weight ranged from 3 kg to 43 kg with the median weight of 5 kg. Among the patients, 127 had transposition of great artery (TGA) with ventricular septal defect (VSD), and 81 patients had TGA with intact ventricular septum (IVS) or with the diameter of VSD smaller than 5 mm. Coronary anatomy was normal (1LCX2R) in 151 patients and abnormal in the rest including 15 patients with single coronary artery, 6 with intramural and 36 with inverse coronary artery. Preoperative, perioperative and postoperative clinical data of all patients were collected to establish a database which was then analyzed by univariate analysis and multivariate logistic regression analysis to find out the risk factors formortality in ASO. Results There were 24 perioperative deaths (11.54%) in which 12 died of postoperative infection with multiple organ failure (MOF), 10 died of low cardiac output syndrome, 1 died of pulmonary hypertension, and 1 died of cerebral complications. Among them, 20 patients (18.30%) died in early years from 2001 to 2005, while only 4 (4.00%) died in the time period from 2006 to 2007, which was a significant decrease compared with the former period (Plt;0.05). The univariate analysis revealed that cardiopulmonary bypass (CPB) time was significantly longer in the death group than in the survival group(236±93 min vs. 198±50 min, P=0.002), and occurrence of major coronary events (33.3% vs. 2.2%, P=0.000) and unusual coronary artery patterns(33.3% vs. 6.5%,P=0.000) were much more in the death group than in the survival group. Multivariate logistic regression analysis showed that early year of [CM(159mm]operation (OR=7.463, P=0.003), unusual coronary artery patterns (OR=6.303,P=0.005) and occurrence of majorcoronary events (OR=17.312, P=0.000) were independent predictors for perioperative mortality. Conclusion The ASO can be performed with low perioperative mortality in our hospital currently. Occurrence of major coronary events, unusual coronary artery patterns and year of surgery before 2006 are independent predictors for perioperative mortality.

    Release date:2016-08-30 06:01 Export PDF Favorites Scan
  • 体外膜式氧合在大动脉转位术后心室功能恢复与训练中的应用

    摘要: 目的 评价体外膜式氧合(extracorporeal membrane oxygenation, ECMO)支持在婴幼儿大动脉错位(TGA)患者大动脉转位术(ASO)后心室功能恢复和适应性训练的临床结果及可行性。 方法 2005年1月至2008年8月,北京阜外心血管病医院7例TGA患者接受ASO后需要ECMO支持,其中男3例,女4例;年龄3周~14个月。ASO后心室不能适应新的血流动力学和/或合并心功能受损,采用静脉-动脉-ECMO辅助,占同期小儿先天性心脏病患者术后应用ECMO的36.84%(7/19)。插管途径为经胸右心房引流,升主动脉灌注;采用ECMO 系统为:Biomedicu(Medtronic)4例, Jostra 2例,Medos 1例;辅助流量20~100 ml/kg。 结果 7例患者平均转流时间174 h(64~266 h),心室训练时间平均96 h。4例成功脱离ECMO,脱机率5714%(4/7); 3例出院。死亡4例,其中3例不能脱离ECMO直接死亡,死亡原因为肾功能衰竭1例,出血1例,多器官功能衰竭1例;1例在脱离ECMO后6 d感染死亡。 结论 ECMO能为TGA患者ASO后心功能的恢复和左心室适应性训练提供有效的支持。

    Release date:2016-08-30 06:03 Export PDF Favorites Scan
  • Longterm Followup of Left Ventricular Function and Aortic Valve Regurgitation after Rapid Twostage Arterial Switch Operation

    Abstract: Objective To investigate the longterm complications and preventions of rapid twostage arterial switch operation through longterm follow-up. Methods We reviewed the clinical information of 21 patients of rapid twostage arterial switch operation from September 2002 to September 2007 in Shanghai Children’s Medical Center. Among them, there were 13 males and 8 females with an average age of 75 d (29-250 d) and an average weight of 5 kg (3.5-7.0 kg). The data of left ventricle training period and the data before and after the twostage arterial switch operation were analyzed, and the risk factors influencing the aortic valve regurgitation were analyzed by the logistic multivariable regression analysis. Results The late diameter of anastomosis of pulmonary and aortic artery were increased compared with those shortly after operation (0.96±0.30 cm vs. 0.81±0.28 cm, t=-1.183,P=0.262; 1.06±0.25 cm vs. 0.09±0.21 cm, t=-1.833,P=0.094), but there was no significant difference. The late velocity of blood flow across the anastomoses was not accelerated, which indicated no obstruction. The late heart function was better than that shortly after operation, while there was no significant difference between left ventricular ejection fraction(LVEF) during these two periods (62.88%±7.28% vs. 67.92%±7.83%,t=1.362,P=0.202). The late left ventricular end diastolic dimension(LVDd) was significantly different from that shortly after operation (2.16±0.30 cm vs.2.92±0.60 cm,t=-5.281,P=0.003). Compared with earlier period after operation, the thickness of left ventricular posterior wall thickness(LVPWT)was also increased (0.39±0.12 cm vs. 0.36±0.10 cm,t=0.700,P=0.500), but there was no significant difference. The postoperative aortic valve regurgitation was worsened in 4 patients (30.77%, 4/13), not changed in 7 patients and alleviated in 2 patients compared with that before operation. There was no severe regurgitations during the followup. The logistic regression analysis showed that the small preoperative diameter ratio of aortic valve to pulmonary valve and long follow-up time were two risk factors for the [CM(159mm]aggravation of aortic regurgitation. Conclusion There is a relatively high aortic regurgitation rate after rapid two stage arterial switch operation, but there is no later death or reoperation and the survival conditions are satisfactory. All patients must be followed up periodically to check the anastomosis of pulmonary and aortic arteries and the aortic valve.

    Release date:2016-08-30 06:03 Export PDF Favorites Scan
  • Followup Study on the Growth of Anastomotic Stoma after Arteries Switch Operation

    Objective To analyze the growth of anastomotic stoma of aortic(AO) and pulmonary artery (PA) after arteries switch operation(ASO) so as to assess the longterm efficacy of ASO . Methods The data of 331 patients who had undergone ASO in Shanghai Children’s Medical Center of Jiaotong University from December 1999 to December 2007 was analysed retrospectively. One hundred eleven patients had complete transposition of great arteries complicated with intact ventricular septum(TGA/IVS), 123 had complete transposition of great arteries complicated with ventricular septal defect(TGA/VSD), 73 had TaussigBing complicated with ventricular septal defect and pulmonary hypertension, and 24 underwent StageSwitch. Of the 331 patients 228 were followedup, and the followup time was 20.4±18.6 months. There were 752 ultrasonic cardiograph reports, 3.3per patient on average. The growth of anastomosis was analysed according to the diameters of AO and PA. Results The AO and PA anastomosis diameters of TGA/IVS patients(before discharge 0.74±0.17 cm and 0.65±0.13 cm, latest followup 1.09±0.31cm and 0.84±0.21 cm), TGA/VSD patients (before discharge 0.76±0.20 cm and 0.63±0.14 cm, latest followup 1.09±0.24 cm and 0.82±0.22 cm) and TaussigBing patients(before discharge 0.84±0.25 cm and 0.74±0.20 cm, latest followup 1.05±0.30 cm and 0.85±0.24 cm) growed significantly(Plt;0.05). The AO anastomotic stoma diameters of patients who had underwent StageSwtich (before discharge 0.93±0.19 cm, latest followup 1.19±0.29 cm) growed significantly(Plt;0.05). The PA anastomotic stoma diameter growed(before discharge 0.90±0.27 cm, latest followup 1.00±0.32 cm), but had no statistical significance (P>0.05). Till November 2008, Six patients needed reoperation because of the right or left ventricle outflow tract obstruction. After reoperation, 3 had no residual obstruction, 3 had residual obstruction. Conclusion After the section and suture of ASO, aortic and pulmonary artery can grow with age, but sometimes stenosis happens to some patients. During the followingup, some patients need reoperation.

    Release date:2016-08-30 06:05 Export PDF Favorites Scan
  • Classification and Surgical Management of Coronary Arterial Anomalies in Complete Transposition of the Great Arteries

    Abstract: The complete transposition of the great arteries (TGA) is one of the commonest congenital cardiac anomalies in cyanosis. In untreated patients, death occurs early in infancy. Nowadays arterial switch operation (ASO) has been widely proposed to treat TGA without pulmonary valve stenosis. Meanwhile, surgical risks and mortality will be increased if TGA is accompanied by coronary arterial anomalies. So proper surgical management of abnormal coronary artery has a significant influence on the outcome of ASO. The classification, operation methods and surgical results were reviewed in this article.

    Release date:2016-08-30 06:08 Export PDF Favorites Scan
  • Investigation of Risk Factors Influencing the Mortality of the Arterial Switch Operation

    Objective To analyze the outcome of arterial switch operation (ASO) for surgical repair of complete transposition of the great arteries (TGA), and to investigate the risk factors influencing the mortality of ASO. Methods The clinical data of patients suffered from TGA and treated with ASO from the January 2003 to December 2004, and the clinical records in hospital including eehoeardiogram and operation record were collected. The clinical data were analyzed by chi-squared test and logistic muhivariable regression analysis, including the age undergone operation, body weight, diagnosis, anatomic type of coronary artery, cardiopulmonary bypass time, aortic crossclamping time, circulation arrest time, assisted respiration time after operation, the delayed closure of sternum and so on. The risk factors influencing the early mortality of the ASO were analyzed. Results Sixty seven patients were operated with ASO, five patients died during the peri-operative period. The outcome of univariate analysis indicated that risk factors influencing the mortality of ASO included: age(P=0. 004), body weight (P=0. 042), anatomic type of coronary artery (P= 0. 006) and extracorporeal circulation time (P= 0. 048), the length of the CICU stay(P= 0. 004) and the hospital stay(P=0. 007) after operation in the TGA/VSD patients were longer than those in TGA/ IVS patients. The logistic muhivariable regression analysis indicated that the age at operation (P= 0. 012), coronary arteries anomaly (P = 0.001 )and the longer cardiopulmonary bypass time (P = 0. 002) were correlated with the increase of death rate. Conclusion It could be good results for TGA patients who was repaired with ASO. The age at operation, the coronary arteries anomaly and the longer cardiopulmonary bypass time are the risk factors influencing the mortality.

    Release date:2016-08-30 06:22 Export PDF Favorites Scan
  • Rapid two-stage arterial switch operation for neonatal D-transposition of the great arteries

    Objective To review and summarize the clinical outcomes of neonatal D-transposition of the great arteries by rapid two-stage arterial switch operation. Methods Between September 2002 and May 2003, five neonates with D-transposition of the great arteries were repaired by rapid two-stage arterial switch operation. The operative age was 83.0±72.2 day and weight was 4.7±0.9 kg. Because these patients came to the hospital late, the left ventricle was unable to accommodate the systemic pressure, so the left ventricle had to be prepared by pulmonary artery banding and systemic-pulmonary arterial shunt. After 6-9 days, the arterial switch procedure was performed. Results At first stage, one patient died of supraventricular tachycardia and oliguria after peritoneal dialysis. Four patients were repaired by arterial switch operation with no death. These patients were followed up for 2 to 10 months and had good development. The echocardiogram showed that there were no intracardiac residual shunt , the aorta and pulmonary artery anastomosis had no obstruction . The heart function was good, ejection fraction 0.68-0.77,fractional shortening 0.24-0.37. One patient had mild aortic valve regurgitation. Conclusion Rapid two-stage arterial switch operation is the best way for neonatal D-transposition of the great arteries that the left ventricle was unable to accommodate the systemic pressure.

    Release date:2016-08-30 06:27 Export PDF Favorites Scan
  • 以跗外侧血管为蒂的骰骨瓣转位术

    以跗外侧血管为蒂的骰骨瓣具有血管位置恒定、表浅,易于解剖的特点。本骨瓣主要用于踝关节,距下关节融合和距骨颈骨折开放复位需植骨者,也适于其它邻近骨与关节病损部植骨。

    Release date:2016-09-01 11:38 Export PDF Favorites Scan
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