國立臺灣大學醫學院外科邱英世2006-07-262018-07-112006-07-262018-07-112005-12-31http://ntur.lib.ntu.edu.tw//handle/246246/24550大動脈轉位手術已成為大動脈完全轉位病例之常規手術及選擇術式。但術後併發瓣 膜上性肺動脈狹窄仍為目前存在之問題。有些左右肺動脈形成不良在大動脈轉位手術之 前即已存在。我們比較大動脈完全轉位病例術前和術後之肺動脈血管攝影擬找出發生左 右肺動脈形成不良之機轉。並比較兩種分期性手術（分流手術或加上肺動脈幹束紮）及 兩種治本性手術後（心房轉位手術與大動脈轉換手術）之成長情形。我們發現只做分流 手術之病例（n=3）肺動脈會變小，如加上肺動脈幹束紮（n=2），使心舒期也有左至右 分流才能讓肺動脈生長。心房轉位手術（n=4）使肺動脈幹仍居後位，比大動脈轉換手 術（n=14）術後肺動脈生長情形差。此術後病史與我們之前發表自然病史發病之機轉雷 同。簡言之，大動脈完全轉位發生左右肺動脈形成不良之機轉為存開性動脈導管或外科 分流術造成右至左分流形成血行力學性飢餓有關，以及後位性肺動脈幹（肺動脈幹後緣 與左右肺動脈前緣角度較小）所造成，我們認為針對此病理發生之術式才能避免瓣膜上 性肺動脈狹窄。In the present era of arterial switch operation, supravalvular pulmonary stenosis remains a problem. First branch pulmonary arterial hypoplasia in transposition of the great arteries was documented prior to and after palliative or corrective surgery. We sought to determine the morphological features of the pulmonary trunk (PT) and its branches susceptible to first branch pulmonary arterial (PA) hypoplasia in transposition of the great arteries (TGA). All available angiograms between 1981 and 2003 were reviewed and polaroid photos were taken at end-systolic phase. The diameters of the right PA (RPA), the left PA (LPA) and the PT before their first branch, and the angle between the RPA and right border of the PT were measured in frontal view. In addition, the angle between both PA and posterior border of the PT, and the diameter of the ascending aorta were measured in lateral view. The diameter ratio of PA to PT was compared before and after two palliative operations (shunt with or without concomitant PT banding) and two corrective operations (Senning or Jatene). We found that shunt alone (n=3) had regression of PA size. Whereas those who had concomitant PT banding (n=2) to abolish hemodynamic starvation had PA growth. Those who underwent Senning operation (n=4) had PA growth, but the growth was not as good and rapid as Jatene group with Lecompte maneuver (n=14).Thus the natural and second natural history of PA hypoplasia in TGA is about the same, namely, hemodynamic starvation and posterior inclination of PT 2 would lead to PA hypoplasia in TGA both before and after surgical intervention. We conclude that the surgical options that eliminate the-above-mentioned pathogenesis of PA hypoplasia like shunt with PT banding or Jatene with Lecompte (or had better with Pacifico or spiral reconstruction) could facilitate PA growth in TGA.application/pdf2253113 bytesapplication/pdfzh-TW國立臺灣大學醫學院外科左右肺動脈形成不良Senning 手術大動脈轉換手術大動脈完全轉位瓣 膜上性肺動脈狹窄Lecompte 手法First branch pulmonary arterial hypoplasiaSenning operationArterial switch operationTransposition of the great arteriesSupravalvular pulmonary stenosisLecompte maneuverreporthttp://ntur.lib.ntu.edu.tw/bitstream/246246/24550/1/932314B002238.pdf