目的 評(píng)價(jià)左室訓(xùn)練術(shù)治療先天性矯正型大動(dòng)脈轉(zhuǎn)位（cCTGA）的臨床療效?！》椒ā?005年5月至2011年5月，阜外心血管病醫(yī)院對(duì)24例左心室退化的cCTGA患者行左室訓(xùn)練術(shù)，其中男 13例，女 11例；年齡0.17～22.00 （3.73±4.35）歲；體重5.10～61.00 （15.71±10.95） kg。主要合并畸形：三尖瓣關(guān)閉不全（TR）23例（輕度11例、中度7例、重度5例），限制型室間隔缺損18例，房間隔缺損5例，卵圓孔未閉5例，動(dòng)脈導(dǎo)管未閉4例，肺動(dòng)脈瓣輕度狹窄5例，主動(dòng)脈弓縮窄1例。術(shù)前經(jīng)超聲心動(dòng)圖、心血管造影或心導(dǎo)管檢查確診，形態(tài)學(xué)左心室舒張期末內(nèi)徑（mLVEDD）8～32 （21.56±6.60） mm，形態(tài)學(xué)左心室（mLV）后壁厚度2～7（4.29±1.52） mm，形態(tài)學(xué)左心室與形態(tài)學(xué)右心室（mRV）壓力比（PmLV/mRV） 0.12～0.65 （0.41±0.12）。手術(shù)均采用胸骨上端小切口或胸骨正中切口，在全身麻醉下完成肺動(dòng)脈環(huán)縮術(shù)?！〗Y(jié)果 術(shù)畢測(cè)壓PmLV/mRV 0.57～0.93 （0.76±0.10）；全組患者無(wú)住院死亡，出院時(shí)超聲心動(dòng)圖檢查提示：雙心室結(jié)構(gòu)和功能良好，室間隔位置較術(shù)前略向mRV側(cè)移位，mLVEDD較術(shù)前略增大，TR較術(shù)前減輕。術(shù)后隨訪1～35個(gè)月，無(wú)遠(yuǎn)期死亡。所有患者一般情況好，生命體征平穩(wěn)，心功能分級(jí)（NYHA）Ⅰ～Ⅱ級(jí)，mLVEDD 14～40 （26.17±7.11） mm，mLV后壁厚度4～9 （4.95±1.44） mm，PmLV/mRV 0.52～0.98 （0.72±0.16），TR較術(shù)前明顯減輕，其中14例患者完成二期心房大動(dòng)脈雙調(diào)轉(zhuǎn)術(shù)?！〗Y(jié)論 左室訓(xùn)練術(shù)應(yīng)用于左心室退化的cCTGA患者安全有效，mLV壓力負(fù)荷及后壁厚度增加，mLV腔擴(kuò)大，且TR顯著減輕。
引用本文： 崔彬,李守軍,閆軍,沈向東,王旭,花中東,楊克明. 左室訓(xùn)練術(shù)治療先天性矯正型大動(dòng)脈轉(zhuǎn)位的臨床療效分析. 中國(guó)胸心血管外科臨床雜志, 2012, 19(4): 350-353. doi: 復(fù)制
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| 2. | Lim HG， Lee JR， Kim YJ， et al. Outcomes of biventricular repair for congenitally corrected transposition of the great arteries. Ann Thorac Surg， 2010， 89 （1）：159-167. |
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| 7. | Poirier NC， Yu JH， Brizard CP， et al. Long-term results of left ventricular reconditioning and anatomic correction for systemic right ventricular dysfunction after atrial switch procedures. J Thorac Cardiovas Surg， 2004， 127 （4）：975-981. |
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| 10. | Quinn DW， McGuirk SP， Metha C， et al. The morphologic left ventricle that requires training by means of pulmonary artery banding before the double-switch procedure for congenitally corrected transposition of the great arteries is at risk of late dysfunction. J Thorac Cardiovasc Surg， 2008， 135 （5）：1137-1144. |
| 11. | Honjo O， Kawada M， Akagi T， et al. Left ventricular retraining and anatomic correction in teenage patient with congenitally corrected transposition of the great arteries. Circ J， 2007， 71 （4）：613-616. |
| 12. | Uno Y， Morita K， Ko Y， et al. Double switch operation for congenitally corrected transposition of the great arteries after two-staged pulmonary artery banding. Jpn J Thorac Cardiovasc Surg， 2006， 54 （1）：40-43. |
| 13. | Corno AF， Ladusans EJ， Marco P， et al. Flowatch versus conventional pulmonary artery banding. J Thorac Cardiovasc Surg， 2007， 34 （6）：1413-1420. |
| 14. | Ly M， Belli E， Leobon B， et al. Results of the double switch operation for congenitally corrected transposition of the great arteries. Eur J Cardiothorac Surg， 2009， 35 （5）：879-884. |
| 15. | Marcy LS， Kimberlee G， Pedro del N， et al. Long-term predictors of aortic root dilation and aortic regurgitation after arterial switch operation. Circulation， 2004， 110 （Suppl Ⅱ）：II128-II132. |
- 1. Hornung TS， Calder L. Congenitally corrected transposition of the great arteries. Heart， 2010， 96 （14）：1154-1161.
- 2. Lim HG， Lee JR， Kim YJ， et al. Outcomes of biventricular repair for congenitally corrected transposition of the great arteries. Ann Thorac Surg， 2010， 89 （1）：159-167.
- 3. Hörer J， Schreiber C， Krane S， et al. Outcome after surgical repair/palliation of congenitally corrected transposition of the great arteries. Thorac Cardiovasc Surg， 2008， 56 （7）：391-397.
- 4. Bautista-Hernandez V， Marx GR， Gauvreau K， et al. Determinants of left ventricular dysfunction after anatomic repair of congenitally corrected transposition of the great arteries. Ann Thorac Surg， 2006， 82 （6）：2059-2066.
- 5. Devaney EJ， Charpie JR， Ohye RG， et al. Combined arterial switch and Senning operation for congenitally corrected transposition of the great arteries：patient selection and intermediate results. J Thorac Cardiovasc Surg， 2003， 125 （3）：500-507.
- 6. Boutin C， Jonas RA， Sanders SP， et al. Rapid two-switch arterial switch operation.Acquisition of left ventricular mass after pulmonary artery banding in infants with transposition of the great arteries. Circulation， 1994， 90 （3）：1304- 1309.
- 7. Poirier NC， Yu JH， Brizard CP， et al. Long-term results of left ventricular reconditioning and anatomic correction for systemic right ventricular dysfunction after atrial switch procedures. J Thorac Cardiovas Surg， 2004， 127 （4）：975-981.
- 8. Winlaw DS， McGuirk SP， Balmer C， et al. Intention-to-treat analysis of pulmonary artery banding in conditions with a morphological right ventricle in the systemic circulation with a view to anatomic biventricular repair. Circulation， 2005， 111 （4）：405-411.
- 9. Metton O， Gaudin R， Ou P， et al. Early prophylactic pulmonary artery banding in isolated congenitally corrected transposition of the great arteries. Eur J Cardiothorac Surg， 2010， 38 （6）：728-734.
- 10. Quinn DW， McGuirk SP， Metha C， et al. The morphologic left ventricle that requires training by means of pulmonary artery banding before the double-switch procedure for congenitally corrected transposition of the great arteries is at risk of late dysfunction. J Thorac Cardiovasc Surg， 2008， 135 （5）：1137-1144.
- 11. Honjo O， Kawada M， Akagi T， et al. Left ventricular retraining and anatomic correction in teenage patient with congenitally corrected transposition of the great arteries. Circ J， 2007， 71 （4）：613-616.
- 12. Uno Y， Morita K， Ko Y， et al. Double switch operation for congenitally corrected transposition of the great arteries after two-staged pulmonary artery banding. Jpn J Thorac Cardiovasc Surg， 2006， 54 （1）：40-43.
- 13. Corno AF， Ladusans EJ， Marco P， et al. Flowatch versus conventional pulmonary artery banding. J Thorac Cardiovasc Surg， 2007， 34 （6）：1413-1420.
- 14. Ly M， Belli E， Leobon B， et al. Results of the double switch operation for congenitally corrected transposition of the great arteries. Eur J Cardiothorac Surg， 2009， 35 （5）：879-884.
- 15. Marcy LS， Kimberlee G， Pedro del N， et al. Long-term predictors of aortic root dilation and aortic regurgitation after arterial switch operation. Circulation， 2004， 110 （Suppl Ⅱ）：II128-II132.