Background:The survival rate of patients following arterial switch operation(ASO)exceeds 95%,but coronary artery anomalies(CAA)contribute to a 2%incidence of sudden cardiac arrest later in life.Therefore,we aimed to a...Background:The survival rate of patients following arterial switch operation(ASO)exceeds 95%,but coronary artery anomalies(CAA)contribute to a 2%incidence of sudden cardiac arrest later in life.Therefore,we aimed to assess abnormal findings of coronary arteries in post-ASO patients.Methods:Coronary computed tomography angiography(CCTA)is performed on post-ASO patients who meet institutional criteria.Intraoperative findings of coronary artery patterns were retrospectively reviewed and categorized using the Leiden classification system.Coronary artery anomalies were detected by CCTA and associations with coronary artery compromise were explored.Results:Forty-three patients who had CCTA with a median age of 15.6 years(12–21.3 years)were included in the study.Unusual coronary patterns were identified in 20(46%)patients before ASO.CCTA identified 25 CAA in 22 patients(eleven with prepulmonic course,nine with interarterial course,three with acute take-off angle,and two with significant stenosis).Postoperative CAA was more common in patients with unusual coronary patterns(90%vs.17.4%;p<0.001).Nine patients experienced chest pain and two patients required coronary artery bypass graft.A common ostium of RCA and LAD or LMCA were associated with significant chest pain(OR 14.3%,95%CI 2.5 to 82.3).Conclusions:Coronary artery anomalies in post-ASO are common.All post-ASO patients should have coronary artery imaging before participating in competitive sport and when they reach adolescence.Patients with unusual preoperative coronary artery patterns should undergo coronary artery imaging when feasible.Follow-up imaging studies are indicated in patients with post-operative coronary artery abnormalities.展开更多
目的 探讨大动脉调转术（ASO）治疗大动脉转位（TGA）患儿的中、长期疗效,及观察术后主动脉瓣反流及吻合口梗阻情况.方法 以2003年1月至2009年12月在本研究所行ASO的TGA患儿166例为研究对象,按室间隔是否完整分为TGA合并室间隔缺损组（...目的 探讨大动脉调转术（ASO）治疗大动脉转位（TGA）患儿的中、长期疗效,及观察术后主动脉瓣反流及吻合口梗阻情况.方法 以2003年1月至2009年12月在本研究所行ASO的TGA患儿166例为研究对象,按室间隔是否完整分为TGA合并室间隔缺损组（Ⅰ组）94例、TGA并室间隔完整组（Ⅱ组）72例.所有术后生存患儿均进行随访,超声心动图观察主动脉瓣反流及吻合口梗阻情况.结果 Ⅰ组和Ⅱ组分别有14例和10例患儿住院死亡.所有术后生存患儿平均随访时间（57.41±15.45）个月.随访发现51例患儿出现主动脉瓣反流,多发生于术后3～5年.相关性分析显示主动脉瓣反流面积与随访时间呈正相关（r=0.436,P=0.028）.所有随访病例没有出现主动脉吻合口梗阻（压差＞50 mm Hg,1 mm Hg=0.133 kPa）.Ⅰ组和Ⅱ组肺动脉吻合口梗阻（压差＞50 mm Hg）的发生率分别为6.25％（5/80）和3.23％ （2/62）.结论 ASO是治疗TGA的理想术式,具有良好的中、长期疗效.术后定期随访有助于改善患儿的长期预后.展开更多
目的:评估双调转术(double switch operation)治疗纠正型大动脉转位(corrected transposition of the great ar-tery,CTGA)的手术效果。方法:35例CTGA行Double switch术,其中Senning+ASO(大动脉调转术)20例,Senning+Rastelli术15例。采...目的:评估双调转术(double switch operation)治疗纠正型大动脉转位(corrected transposition of the great ar-tery,CTGA)的手术效果。方法:35例CTGA行Double switch术,其中Senning+ASO(大动脉调转术)20例,Senning+Rastelli术15例。采用回顾性研究的方法,术后1次或多次行超声心动图随访,平均随访(16.8±20.9)月,最长术后8年,最短术后1月。结果:术后右室心肌工作指数较术前明显下降,术后三尖瓣反流减轻。术后总的肺静脉梗阻发生率5.7%,腔静脉梗阻发生率2.8%,左心流出道梗阻发生率11.4%,右心流出道梗阻发生率11.4%,残余分流发生率17.1%。Senning+Rastelli组左室流出道梗阻发生率较高。结论:Double switch术可改善右室功能,减轻三尖瓣反流,术后残余分流及梗阻发生率较低,是治疗CTGA的理想手术方法。展开更多
Introduction:Transposition of the great arteries(TGA)with aortopulmonary window is a rare type of congenital heart disease with limited experience.We reported a neonate aged 25 days receiving the arterial switch opera...Introduction:Transposition of the great arteries(TGA)with aortopulmonary window is a rare type of congenital heart disease with limited experience.We reported a neonate aged 25 days receiving the arterial switch operation and assisted with extracorporeal membrane oxygenation.Conclusion:TGA with aortopulmonary window can be safely correctly with the arterial switch operation.展开更多
文摘Background:The survival rate of patients following arterial switch operation(ASO)exceeds 95%,but coronary artery anomalies(CAA)contribute to a 2%incidence of sudden cardiac arrest later in life.Therefore,we aimed to assess abnormal findings of coronary arteries in post-ASO patients.Methods:Coronary computed tomography angiography(CCTA)is performed on post-ASO patients who meet institutional criteria.Intraoperative findings of coronary artery patterns were retrospectively reviewed and categorized using the Leiden classification system.Coronary artery anomalies were detected by CCTA and associations with coronary artery compromise were explored.Results:Forty-three patients who had CCTA with a median age of 15.6 years(12–21.3 years)were included in the study.Unusual coronary patterns were identified in 20(46%)patients before ASO.CCTA identified 25 CAA in 22 patients(eleven with prepulmonic course,nine with interarterial course,three with acute take-off angle,and two with significant stenosis).Postoperative CAA was more common in patients with unusual coronary patterns(90%vs.17.4%;p<0.001).Nine patients experienced chest pain and two patients required coronary artery bypass graft.A common ostium of RCA and LAD or LMCA were associated with significant chest pain(OR 14.3%,95%CI 2.5 to 82.3).Conclusions:Coronary artery anomalies in post-ASO are common.All post-ASO patients should have coronary artery imaging before participating in competitive sport and when they reach adolescence.Patients with unusual preoperative coronary artery patterns should undergo coronary artery imaging when feasible.Follow-up imaging studies are indicated in patients with post-operative coronary artery abnormalities.
文摘目的 探讨大动脉调转术（ASO）治疗大动脉转位（TGA）患儿的中、长期疗效,及观察术后主动脉瓣反流及吻合口梗阻情况.方法 以2003年1月至2009年12月在本研究所行ASO的TGA患儿166例为研究对象,按室间隔是否完整分为TGA合并室间隔缺损组（Ⅰ组）94例、TGA并室间隔完整组（Ⅱ组）72例.所有术后生存患儿均进行随访,超声心动图观察主动脉瓣反流及吻合口梗阻情况.结果 Ⅰ组和Ⅱ组分别有14例和10例患儿住院死亡.所有术后生存患儿平均随访时间（57.41±15.45）个月.随访发现51例患儿出现主动脉瓣反流,多发生于术后3～5年.相关性分析显示主动脉瓣反流面积与随访时间呈正相关（r=0.436,P=0.028）.所有随访病例没有出现主动脉吻合口梗阻（压差＞50 mm Hg,1 mm Hg=0.133 kPa）.Ⅰ组和Ⅱ组肺动脉吻合口梗阻（压差＞50 mm Hg）的发生率分别为6.25％（5/80）和3.23％ （2/62）.结论 ASO是治疗TGA的理想术式,具有良好的中、长期疗效.术后定期随访有助于改善患儿的长期预后.
文摘目的:评估双调转术(double switch operation)治疗纠正型大动脉转位(corrected transposition of the great ar-tery,CTGA)的手术效果。方法:35例CTGA行Double switch术,其中Senning+ASO(大动脉调转术)20例,Senning+Rastelli术15例。采用回顾性研究的方法,术后1次或多次行超声心动图随访,平均随访(16.8±20.9)月,最长术后8年,最短术后1月。结果:术后右室心肌工作指数较术前明显下降,术后三尖瓣反流减轻。术后总的肺静脉梗阻发生率5.7%,腔静脉梗阻发生率2.8%,左心流出道梗阻发生率11.4%,右心流出道梗阻发生率11.4%,残余分流发生率17.1%。Senning+Rastelli组左室流出道梗阻发生率较高。结论:Double switch术可改善右室功能,减轻三尖瓣反流,术后残余分流及梗阻发生率较低,是治疗CTGA的理想手术方法。
文摘Introduction:Transposition of the great arteries(TGA)with aortopulmonary window is a rare type of congenital heart disease with limited experience.We reported a neonate aged 25 days receiving the arterial switch operation and assisted with extracorporeal membrane oxygenation.Conclusion:TGA with aortopulmonary window can be safely correctly with the arterial switch operation.
