THE POTENTIAL FOR SUBPULMONARY OBSTRUCTION IN COMPLETE TRANSPOSITION AFTER THE ARTERIAL SWITCH PROCEDURE - AN ANATOMIC STUDY

被引：7

作者：

BOYADJIEV, K ^{[1
]}

HO, SY ^{[1
]}

ANDERSON, RH ^{[1
]}

LINCOLN, C ^{[1
]}

机构：

[1] NATL HEART & LUNG INST,DEPT PAEDIT,POVEHOUSE ST,LONDON SW3 6LY,ENGLAND

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1990年 / 4卷 / 04期

关键词：

Complete transposition; Sub-aortic obstruction; Sub-pulmonary obstruction; Ventricular septal defect;

D O I：

10.1016/1010-7940(90)90008-N

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Increasing experience with the arterial switch procedure has revealed that, in some instances, obstruction of the newly created sub-pulmonary outflow tract is a major problem. In this study, we examined the right ventricular outflow tract in 51 specimens of complete transposition, 18 of which were associated with a ventricular septal defect. We focussed our attention on the musculature which made up the outflow region and considered variations from that found in the normal right ventricle. Our gross observations showed differences in morphology which produced a sharper angulation between inflow and outflow when compared to the normal. Discrete outflow obstruction was found in 11 hearts (8 with ventricular septal defect and 3 with an intact ventricular septum). The obstruction was due to deviation of the outlet septum in 5, and anomalous muscle bundle in 1, hypertrophy of septomarginal and septoparietal trabeculations in 3 and circumferential infundibular hypertrophy in 2 hearts. Coexisting obstruction of the left ventricular outflow was present in 3 hearts. The anatomical substrates of discrete obstruction should be identified by preoperative cross-sectional echocardiography and/or angiography. Modifications in surgical techniques or radical resection of the obstructing musculature could then be performed to avoid the problem of subpulmonary obstruction after the arterial switch procedure. © Springer-Verlag.

引用

页码：214 / 218

页数：5

共 10 条

[1]

Anderson R.H., Becker A.E., Van Mierop L.H.S., What should we call the “crista”?, Br Heart J, 39, pp. 856-859, (1977)

[2]

Becker A.E., Becker M.J., Edwards J.E., Anomalies associated with coarctation of the aorta. Particular reference to infancy, Circulation, 41, pp. 1067-1075, (1970)

[3]

Castaneda A.R., Trusler G.A., Paul M.H., Blackstone E.H., Kirklin J.W., The early results of treatment of simple transposition in the current era, J Thorac Cardiovasc Surg, 95, pp. 14-28, (1988)

[4]

Jatene A.D., Fontes V.F., Paulista P.P., De Souza L.C.B., Neger F., Galantier M., Souza J.E.M.R., Anatomic correction of transposition of the great vessels, J Thorac Cardiovasc Surg, 72, pp. 364-370, (1976)

[5]

Kanter K.R., Anderson R.H., Lincoln C., Rigby M.L., Shinebourne E.A., Anatomic correction for complete transposition and double-outlet right ventricle, J Thorac Cardiovasc Surg, 90, pp. 690-699, (1985)

[6]

Milanesi O., Thiene G., Bini R.M., Pellegrino P.A., Complete transposition of great arteries with coarctation of aorta, Br Heart J, 48, pp. 566-571, (1982)

[7]

Norwood W.I., Dobell A.R., Freed M.D., Kirklin J.W., Blackstone E.H., Intermediate results of the arterial switch repair. A 20-institution study, J Thorac Cardiovasc Surg, 96, pp. 854-863, (1988)

[8]

Rossi M.B., Ho S.Y., Anderson R.H., Kanter K., Rigby M.L., Lincoln C., Morphological observations following “Anatomical Correction” for abnormal ventriculo-arterial connection, Thorac Cardiovasc Surg, 33, pp. 210-214, (1985)

[9]

Trusler G.A., Castaneda A.R., Rosenthal A., Blackstone E.H., Kirklin J.W., Results of the managment of patients with transpositon of the great arteries in the current area, JACC, 10, pp. 1061-1071, (1987)

[10]

Waldman J.D., Schneeweiss A., Edwards W.E., Lamberti J.J., Shem-Tov A., Neufeld H.N., The obstructive subaortic conus, Circulation, 70, pp. 339-344, (1984)

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