Arterial Switch Operation For The Congenital Heart Disease In Children

ObjectiveWith the development of medical technology, the surgical treatment of complex congenital heart disease in children is greatly improved, tailor-made individual therapy has been gradually put on the agenda, this article focuses on reviewing and summing up the clinical experience of arterial switch operation(ASO), which is used for complex congenital heart disease (including Complete transposition of great arteries and Taussig-Bing heart malformations)in children, in order to discussing the treatment principles of ASO.MethodsThe surgical group treated 57 children with complex congenital heart disease by arterial switch operation from June 2003 to October 2010, in which 41 cases were complete transposition of great arteries and 16 cases were Taussig-Bing heart malformations,38 males and 19 females, age ranged from 6 days to 9 years old, weight ranged from 2.55 to 18 kg, TGA/IVS 16 cases, TGA/VSD 25 cases, associated with atrial septal defect in 11 cases, patent ductus arteriosus in 33 cases, mild pulmonary valve stenosis in 8 cases.All patients were treated with ASO under cardiopulmonary bypass (CPB), anesthesia, superior and inferior vena cava cannulas were inserted respectively or single-tube inserted in right atrial appendage, then established CPB, cold blood cardioplegia or HTK solution was used for myocardial preservation. Explored heart through right atrium, aortic root and pulmonary artery roots and completed VSD repair via right atrium or pulmonary artery, repaired ventricular septal defect with Dacron patch in children with Taussig-Bing heart malformations, by this time, pulmonary artery across the left ventricle, then underwent ASO, meanwhile, corrected malformations and did modified ultrafiltration after stopping CPB.SPSS 13.0 software was used for statistical processing and analysis, measurement data were indicated by x±s, "t test" was used for statistical analysis. P<0.05 was considered that difference was statistically significant.ResultsThe CPB time in surgical group was 150-259min (mean±standard deviation, 184.51±27.56 min), aortic clamping time was 78-183min (mean±standard deviation,98.07±27.59 min), there were six deaths in early time after operation, three cases died of hemorrhage (one case due to releasing of suture of PDA), one case died of pulmonary hypertension crisis in the twelfth hour after operation, one case died of renal failure in the fifth day after operation, one case died of low cardiac output syndrome in twenty-second day after operation, postoperative intensive care unit stay was 5-22 days, the hospital stay was 14-48 days. Patients were followed up three months to seven years, one case died, which was a child of single coronary artery and died of pneumonia and heart failure in the sixth month after discharge. Cyanosis in the remaining fifty cases disappeared, activity increased significantly, growth and development were good and quality of life improved significantly, heart function were class I(NYHA classification). Aortic transvalvular pressure difference in eight cases with pulmonary stenosis decreased significantly after surgery.Conclusions(1) ASO is the ideal surgical method for complete transposition of great arteries and Taussig-Bing heart malformations, its short-term and long-term effects are satisfied. For older patients, if their left ventricular developed well, you can still select the arterial switch operation, Age is not an absolute contraindication ASO.(2) For the children who missed the best timing of surgery, evaluate overall state of children before surgery, determine reasonable operative procedures according to the degradation degree of left ventricle and pulmonary artery pressure.(3) The scientific design of coronary artery anastomosis site and delicate anastomosis technique in operation are important factors to ensure early postoperative recovery.(4) Coronary artery anomalies (including intramural coronary artery, single coronary artery) and severe pulmonary hypertension are risk factors for early death in children.(5) Single perfusion of HTK cardioplegia is useful for shortening aortic clamp time and CPB time, also for myocardial protection.