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題名 | Arterial Switch Operation for Transposition of the Great Arteries: Experience from 2000-2002 in Taiwan=大動脈轉換術治療大動脈轉位:臺灣2000∼2002之經驗 |
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作者姓名(中文) | 吳焜烺; 林銘泰; 吳恩婷; 張重義; 邱英世; 陳益祥; 王主科; 吳美環; | 書刊名 | 臺灣兒科醫學會雜誌 |
卷期 | 45:1 民93.01-02 |
頁次 | 頁19-22+60 |
分類號 | 416.263 |
關鍵詞 | 大動脈轉位; 大動脈轉換術; 肺動脈狹窄; 主動脈狹窄; Transposition of the great arteries; Arterial switch operation; Neo-aortic stenosis; Neo-pulmonary stenosis; |
語文 | 英文(English) |
中文摘要 | 大動脈轉換術治療大動脈轉位上前被認為是最佳選擇。由於物術前術中及術後醫療的進步,改善短期結果及長期預後。因此我們分析過去三年來大動脈轉位接受大動脈轉換術治療的結果,從2000年3月到2002年12月收集44位(男30位,女14位)大動脈轉位病人接受大動脈轉換術治療,手術時平均年齡及平均體重分別為14天(4天到6.6歲)和3.3公斤(2.25到18.1公斤),其中有8位(18.8%)病人先接受緩解手術。28位(63.6%)有正常冠狀動脈分布。有5位死亡(死亡率11.4%)。利用回歸分析發現只有心室中膈缺損是手術死亡危險因子(p=0.012)。術後追蹤11月到44月時肺動脈狹窄平均壓力差16.5±18.2mmHg,4位病人(10%)接受氣球擴張術治療另3位病人(7.7%)除了氣球擴張術治療。1位病人有中等程度肺動脈逆流,6位病人有中等程度主動脈逆流。以Kaplan-Meier分析,術後3年時不用再接受介入性導管治療和手術比率是73%。結論,由於由於手術前術中及術後醫療的進步,在新生兒甚至小於2.5公斤體重接受大動脉轉換術治療,均有良好成績,而只有心室中膈缺損是手術危險因子。 |
英文摘要 | Arterial switch operation (ASO) is considered the procedure of choice for transposition of great arteries (TGA). The results and long-term prognosis improved with recent advances in perioperative management. We herein analyze the clinical outcome of patients undergoing ASO at our institution during the past 3 years. From 2000 to 2002, 44 patients (30 male and 14 female) of TGA received ASO. Age at operation varied from 4 days to 6.6 years (median 14 days) with body weight ranged from 2.25kg to 18.1kg (median 3.3kg). Palliative procedure prior to ASO was performed in 8 patients 18.8%. Normal coronary artery pattern was found in 28 patients (63.6%). The early mortality was 11%(5/44). Only associated ventricular septal defect (VSD) was a significant predictor for operative mortality (p=0.012). With a follow-up ranged from 11 to 44 months, the gradient of neo-pulmonary artery stenosis was 16.5±18.2 mmHg. Four patients (10%) received balloon dilatation and the other three (7.7%) underwent reoperation. The gradient of neo-aortic stenosis was 16.5 ±18.2 mmHg that needed to be dilated in three patients (7.7%). The probability free from reintervention was 73% at the 3d postoperative year. One patient had moderate degree of pulmonary valve regurgitation and six had moderate neo-aortic valve regurgitation. In conclusion, the ASO can be performed in infants with satisfactory results, even in those with a body weight less than 2.5kg. Only associated VSD was shown to be a risk factor. |
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