完全性大动脉转位61例诊断分析

来源 :中国实用儿科杂志 | 被引量 : 0次 | 上传用户:kbxbx
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目的 分析完全性大动脉转位(TGA)的解剖类型及血流动力学改变,探讨其适宜的手术方式。方法 采用超声心动图检查结合心导管及心血管造影术,对61 例年龄4 天至13 岁的TGA患儿进行临床分型,并测定有关的血流动力学参数。结果 TGA 合并室间隔完整(IVS) 或极小室间隔缺损(VSD)21 例(34-4% ),动脉血氧饱和度(SaO2) :0-52±0-09,左室压力:~3 个月(5-7±0-5)kPa,~1 岁(4-2±0-3)kPa。TGA 合并VSD19 例(31-2 %) ,SaO2 :0-69 ±0-11 ,左室压力(11-3 ±2-1)kPa。TGA 合并VSD及左室流出道梗阻(LVOTO)21 例(34-4% ),SaO2 :0-75 ±0-09 ,左室与肺动脉间压力阶差(PG) 为(8-7 ±1-7)kPa。左右冠状动脉(CA) 均起源于右冠状窦3 例,均起源于左冠状窦2 例。镜面右位心2 例,右旋心2 例,左旋心1 例。结论 TGA 可单独存在,亦可合并多种心脏畸形,超声心动图可提供临床分型及部分血流动力学参数;心导管检查及心血管造影术更能直接获取血氧及压力资料。 Objective To analyze the anatomic types and hemodynamic changes of complete aortic transposition (TGA) and to explore the appropriate surgical modalities. Methods Echocardiography combined with cardiac catheterization and cardiovascular angiography was performed on 61 TGA children aged 4 days to 13 years old and their hemodynamic parameters were determined. Results TGA combined with ventricular septum integrity (IVS) or ventricular septal defect (VSD) in 21 patients (34-4%), arterial oxygen saturation (SaO2): 0-52 ± 0-09, left ventricular pressure Months (5-7 ± 0-5) kPa, ~ 1 year old (4-2 ± 0-3) kPa. TGA combined VSD19 cases (31-2%), SaO2: 0-69 ± 0-11, left ventricular pressure (11-3 ± 2-1) kPa. TGA with VSD and left ventricular outflow tract obstruction (LVOTO) 21 cases (34-4%), SaO2: 0-75 ± 0-09, pressure gradient (PG) between left ventricular and pulmonary artery was (8-7 ± 1- 7) kPa. Left and right coronary arteries (CA) were originated in the right coronary sinus in 3 cases, both originated in the left coronary sinus in 2 cases. Mirror right centrum in 2 cases, right heart in 2 cases, left ventricular in 1 case. Conclusion TGA can exist alone or in combination with various cardiac malformations. Echocardiography can provide clinical classification and partial hemodynamic parameters. Cardiac catheterization and cardiovascular angiography can directly obtain blood oxygen and pressure data.
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