大动脉转位手术的进展switch 课件

ArterialSwitchOperationatShanghaiChildren sMedicalCenter ShanghaiChildren sMedicalCenterShanghaiJiaotongUniversityZhi weiXu MD CompleteTranspositionoftheGreatArteries d TGA Pathology AbnormalLV PA RV AoconnectionHypoxiaandacidosisaremaincauseofdeathMorbidity 7 9 inCHDSeverecomplicatedCHD PediatricCardiovascularSurgery ProjectHopeandtheShanghaiChildren sMedicalCenterRichardA Jonas TheFirstSwitchOperationwasPerformedbyDr Jonasin1986 2000 1 2007 6TGA IVS115TGA VSD114Stage switch20Taussig Bing56 295 ArterialSwitchOperation ASO ArterialSwitchOperation 2001 2006 Result 153ASO TGA IVS 74 6 8 1 TGA VSD 79 9 11 39 Mortality 9 8 SurgicalresultsofASO 2000 2006 MortalityofASO SurgicalIndication P LV P RVratiomust 0 62 DEcho Rightwardventricularseptum GoodLVconditionMedialventricularseptum EqualpressurebilaterallyLeftwardventricularseptum Requirecardiaccath tomeasuretheLVpressureStageSwitch Rapid2 StageSwitch LVfunctiondecreased cannotaffordthesystemicpressure 1month Intra atrialswitch Senning Mustard maycauseTRandRVfailure TGA IVS18patientsO2Sat Pre op 0 52 0 82 0 70 0 10 Post op 0 70 0 88 0 81 0 12 Rapid2 StageSwitchPAbanding Blalock Taussigshunt StageI Rapid2 StageSwitch StageI PAbanding systemic pulmonaryshuntestablishment LVtraining palliatehypoxemia StageII ASO LVend diastolicVolume LVMass Result P LV P RVRatio LVEF FS LVPWs PulmonaryBanding AtootightbandingwillleadtoNeo AIIdealpLV pRVratio 0 75 0 85Postoperativefocus LVEF FS LVPWs LVMassStageIIop performedwithin7 14daysideally 术后近远期的随访结果 新主动脉瓣膜反流情况 Indication 1 Age 1month 2 Notableleftwardventricularseptum 3 LVMass 35G m2 Rapid2 StageSwitch DoubleOutletRightVentriclewithSub pulmonaryVSD Taussig BingAnomaly Taussig BingAnomaly 1999 12 2006 12ASO46Taussig Bing simple 36Taussig BingwithCOAorIAA10Age 15d 18mon 5 75 4 03mon Weight 1 79 7kg 5 1 1 58kg Taussig Bing畸形 Corrected TGAA VDiscordantCHD Seldomseen 1 ofallCHD commonlywithotherintra cardiacanomalies80 withVSD50 withPS90 withtricuspidanomaly40 developtoCAVBin20years Corrected TGAA VDiscordantCHD Corrected TGASurgicalStrategy Poorlateoutcomeforclassicsurgicaltechniques HighincidenceofTR RVfailure Recentyears Double SwitchOp advocatedAnanatomicalcorrectionIntra atrialswitch Senning Mustard Arterialswitch ASO Rastelli Senning Rastelli10casesSenning ASO4casesAge3m 7y 39 35 27m Weight5 31kg 14 23 8 27kg Double SwitchOp CasesDeathSenning Rastelli102Senning ASO40Mortality14 28 Double SwitchOp Result MildTRrequiresnosurgicalinterventionPre operation RVaffordsystemicpressureRVdilatedTRPost operation RVrecoveryTRdisappearEarlydiagnosisisimportant oritwilldeveloptoOrganicPHNosurgicalindicationPulmonarystenosisRastelliOp only Corrected TGA TGA VSD PSSurgicalOption Rastelli手术 REV Lecompte 手术 JeongRyulLee etal 2004 AorticTranslocation Nikaidoh forD TGA VSD PS TGA VSDPS Rastelli术后 Nikaidoh术后 行Lecompte调转 Nikaidoh手术 生存率 免于再手术率 AorticTranslocation 2004 10 2006 1211casesMale10Female1Age11 5M 6 8M 4m 5yrs Weight9 41kg 3 17kg 5 6 17kg Case11Death12dayspost op MVstraddling Follow up8 1 3year Echo MildAI1NoresidualVSDNoRVOTOandLVOTO AorticTranslocationResult Wesuggest TGA VSD PSwith RestrictVSDStraddlingTVRelativelysmallRVCAcrossoverRVOTsuitableforAorticTranslocationLimitation smallnumberofcasesshortfollow uptime Discussion ArterialSwitchOperation ASO AnoptimalsurgicalstrategyIdeallyperformedwithin2weeksLatestop ageis1month InTGA IVSpatients thepulmonaryresistancedecreasesrapidlyin1monthafterbirth whichwillleadtothedegenerationoftheLVfunction NoLVfailureoccurspost op whenASOisperformedlessthen1month Abnormalcoronaryarteries CAabnormalityinfluencemortality IVS P 0 175 VSD P 0 336 Taussig Bing P 0 015 IncidenceofabnormalC A IncidenceofCAabnormality IVSvs VSDP 0 002 IVSvs Taussig BingP 0 001 VSDvs Taussig BingP 0 365 Abnormalcoronaryarteries TypeBTypeCTypeDTypeETypeF1AD R CX2R AD CX1AD 2R CX1R AD 2CX1R 2AD CXTGA IVS2 2 32TGA VSD3 1 5 1 4 2 7 1 4Taussig B2 1 10 4 13 1 1 1 5 2 17 7 8 2 10 2 7 1 Mortality40 41 25 20 14 NewtechniqueAo rootreducedbyC A Button Analysisofmortalityandoperativeage LateComplicationsofASOFollow up2m 4yr AIorPI AI mild PI mild TGA IVS8 10