大动脉转位手术的进展switch ppt课件.ppt

Arterial Switch Operation at Shanghai Children’s Medical Center ;Complete Transposition of the Great Arteries (d-TGA); Pediatric Cardiovascular Surgery: Project Hope and the Shanghai Children’s Medical Center Richard A.Jonas;;Dx.;Arterial Switch Operation (2001-2006);Result;Surgical results of ASO ( 2000－2006 ); Mortality of ASO;Surgical Indication;Rapid 2-Stage Switch; TGA/IVS 18 patients O2 Sat: Pre-op. 0.52～0.82 （0.70±0.10） Post-op. 0.70～0.88 （0.81±0.12） ;Rapid 2-Stage Switch;? ;P.LV/P.RV Ratio, LVEF/FS LVPWs;Pulmonary Banding;;?Indication: （1）Age 1 month （2）Notable leftward ventricular septum （3）LV Mass 35G/m2 ; Double Outlet Right Ventricle with Sub-pulmonary VSD （ Taussig-Bing Anomaly）;Taussig-Bing Anomaly ;Taussig-Bing 畸形;Corrected-TGA A-V Discordant CHD; Seldom seen, 1% of all CHD, commonly with other intra-cardiac anomalies 80％ with VSD 50％ with PS 90％ with tricuspid anomaly 40％ develop to CAVB in 20 years;Corrected-TGASurgical Strategy;Senning+Rastelli 10 cases Senning+ASO 4 cases Age 3m~ 7y （39±35.27 m） Weight 5~31 kg（14.23± 8.27 kg ） ; Cases Death Senning+Rastelli 10 2 Senning+ASO 4 0 Mortality 14.28 %; Mild TR requires no surgical intervention Pre-operation: RV afford systemic pressure RV dilated TR Post-operation: RV recovery TR disappear Early diagnosis is important, or it will develop to Organic PH No surgical indication Pulmonary stenosis Rastelli Op. only;TGA/VSD/PS Surgical Option;Rastelli手术;REV (Lecompte) 手术; Aortic Translocation ( Nikaidoh )for D-TGA/VSD/PS;;;Aortic Translocation ;Case 11 Death 1