Kuroczynski W, Kampmann C, Choi Y H, Hilker M, Wippermann F, David M, Schmid F X, Heinemann M K, Oelert H
Klinik und Poliklinik für Herz-, Thorax- und Gefässchirurgie Johannes Gutenberg-Universität Mainz Langenbeckstr. 1 55131 Mainz, Germany.
Z Kardiol. 2001 Jul;90(7):498-502. doi: 10.1007/s003920170139.
The aim of this study was to evaluate the incidence of postoperative pulmonary supravalvular stenosis in patients with d-TGA and to assess the rate of success or failure of balloon angioplasty. Out of 70 patients with d-TGA 67 patients underwent successful arterial switch operation. Twelve children developed severe supravalvular pulmonary stenosis with a peak gradient above 50 mmHg (range: 50-120 mmHg). In these patients 19 high pressure dilatations were performed up to a diameter of 130% of the native valve dimension. The mean age at angioplasty was 17 months (range: 3-36 months). Successful intervention was defined as a > 50% decrease of predilatation peak pressure gradient or right ventricular pressure < 50 mmHg. Dilatations were performed without complications. Complete resolution was primarily achieved in 1 patient. In 7 patients the pressure gradients could be reduced to 10-45 mmHg (mean: 25 mmHg). In another two patients a palliative stent-implantation into the pulmonary trunk was necessary to reduce the pressure gradient. Because unsuccessful intervention, two patients needed subsequent operation. During follow-up of 6-9 months after intervention severe restenosis occurred in 3 patients (2 after stent-implantation; 1 after re-re-dilatation) who then also needed operation. Balloon dilatation should be the first treatment in patients with pulmonary stenosis after ASO in TGA owing to the low complication rate and the potential benefit of this procedure. Recurrent and combined stenoses with narrow pulmonary valve annulus should be treated surgically.
本研究的目的是评估矫正性大动脉转位（d-TGA）患者术后肺动脉瓣上狭窄的发生率，并评估球囊血管成形术的成败率。在70例d-TGA患者中，67例成功接受了动脉调转术。12名儿童出现严重的肺动脉瓣上狭窄，峰值压差超过50 mmHg（范围：50-120 mmHg）。对这些患者进行了19次高压扩张，扩张后的直径达到原瓣膜尺寸的130%。血管成形术时的平均年龄为17个月（范围：3-36个月）。成功的干预定义为扩张前峰值压力梯度降低>50%或右心室压力<50 mmHg。扩张过程无并发症发生。1例患者主要实现了完全缓解。7例患者的压力梯度可降至10-45 mmHg（平均：25 mmHg）。另外2例患者需要在肺动脉主干植入姑息性支架以降低压力梯度。由于干预未成功，2例患者需要后续手术。在干预后的6-9个月随访期间，3例患者（2例在植入支架后；1例在再次扩张后）发生严重再狭窄，随后也需要手术。由于并发症发生率低且该手术有潜在益处，球囊扩张应作为TGA患者动脉调转术后肺动脉狭窄患者的首选治疗方法。复发性狭窄和合并狭窄以及肺动脉瓣环狭窄应采用手术治疗。
