Ou Phalla, Mousseaux Elie, Azarine Arshid, Dupont Peggy, Agnoletti Gabriella, Vouhé Pascal, Sidi Daniel, Bonnet Damien
Service de Radiologie Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France.
J Thorac Cardiovasc Surg. 2006 Mar;131(3):639-43. doi: 10.1016/j.jtcvs.2005.11.014.
The main cause of long-term morbidity and mortality after a successful arterial switch operation for transposition of the great arteries is complications at the ostial segments, proximal segments, or both of the retransferred coronary arteries. The purpose of this study was to investigate the clinical usefulness of multislice computed tomographic angiography in detecting ostial and proximal coronary lesions in children having undergone the arterial switch operation for transposition of the great arteries.
Forty-nine children (aged 8.5 +/- 3.9 years) operated on for transposition of the great arteries with the arterial switch operation (follow-up, 8.3 +/- 3.6 years) underwent systematic selective conventional and multislice computed tomographic angiography. The ability of multislice computed tomography in detecting stenosis and other modifications of the coronary arteries' course was analyzed by 2 independent investigators.
Multislice computed tomography, as compared with selective conventional coronary angiography, permitted assessment of ostial and proximal coronary segments in every patient. It correctly detected the 4 (8.1%) patients with significant coronary lesions (1 with ostial and 3 with proximal coronary stenosis) that had been identified by means of conventional angiography. Multislice computed tomography clearly showed an abnormal course of the coronary artery between the great arteries with compression of the ostial (1 patient) and proximal (3 patients) segments of the retransferred coronary arteries.
These results indicate that multislice computed tomographic angiography is fully accurate in detecting ostial coronary artery stenoses, proximal coronary artery stenoses, or both in pediatric patients having undergone the arterial switch operation for transposition of the great arteries. Our results suggest that multislice computed tomography could be used as a screening technique for detecting coronary complications in the follow-up of the arterial switch operation before having recourse to conventional angiography.
大动脉转位成功实施动脉调转术后长期发病和死亡的主要原因是再移植冠状动脉开口段、近端段或两者出现并发症。本研究的目的是探讨多层螺旋计算机断层血管造影术在检测大动脉转位接受动脉调转术患儿的冠状动脉开口和近端病变中的临床应用价值。
49例接受动脉调转术治疗大动脉转位的患儿（年龄8.5±3.9岁，随访时间8.3±3.6年）接受了系统的选择性传统冠状动脉造影和多层螺旋计算机断层血管造影。由2名独立研究人员分析多层螺旋计算机断层扫描检测冠状动脉狭窄及其他走行改变的能力。
与选择性传统冠状动脉造影相比，多层螺旋计算机断层扫描能够对每位患者的冠状动脉开口和近端节段进行评估。它正确检测出4例（8.1%）经传统血管造影确诊的有明显冠状动脉病变的患者（1例开口处病变，3例近端冠状动脉狭窄）。多层螺旋计算机断层扫描清楚地显示了大动脉之间冠状动脉走行异常，再移植冠状动脉开口段（1例患者）和近端段（3例患者）受压。
这些结果表明，多层螺旋计算机断层血管造影术在检测大动脉转位接受动脉调转术的儿科患者的冠状动脉开口狭窄、近端冠状动脉狭窄或两者兼有时完全准确。我们的结果表明，在采用传统血管造影之前，多层螺旋计算机断层扫描可作为动脉调转术后随访中检测冠状动脉并发症的筛查技术。
