Ou Phalla, Celermajer David S, Marini Davide, Agnoletti Gabriella, Vouhé Pascal, Brunelle Francis, Le Quan Sang Kim-Hanh, Thalabard Jean Christophe, Sidi Daniel, Bonnet Damien
University Rene Descartes-Paris V, UFR Necker-Enfants Malades, Department of Pediatric Radiology, 149 rue de Sèvres, Paris Cedex 15, France.
JACC Cardiovasc Imaging. 2008 May;1(3):331-9. doi: 10.1016/j.jcmg.2008.02.005.
We investigated the accuracy of 64-slice computed tomography (CT) angiography, as compared to invasive angiography, to evaluate reimplanted coronary arteries in children after arterial switch operation (ASO) for transposition of the great arteries (TGA).
Assessment of the integrity of reimplanted coronary arteries is crucial for long-term outcome after ASO for TGA. Noninvasive tests have limited accuracy for detecting significant coronary lesions, and invasive coronary angiography is usually required in this setting.
One hundred thirty consecutive children, after ASO for TGA (age 5.6 +/- 1.1 years), underwent conventional invasive coronary angiography and coronary CT angiography using a 64-slice scanner. The ability of CT to detect significant coronary stenoses (>30% diameter reduction) of the coronary ostia and proximal segments, and other abnormalities of the coronary arteries was analyzed by blinded comparison to the invasive coronary angiogram.
The CT was fully evaluable in 126 of 130 patients (97%), allowing assessment of ostia and proximal segments of all coronary arteries. The CT correctly detected all 12 patients (9.2%) in whom invasive coronary angiography had identified significant coronary lesions, with a sensitivity, specificity, and negative predictive value of 100%. In addition, CT showed nonsignificant coronary lesions (<30% luminal narrowing) in 6 patients and allowed determination of the underlying reasons for coronary luminal narrowing, such as stretching or compression of the re-implanted coronary arteries caused by their anatomic relationship to the adjacent great vessels.
64-slice CT coronary angiography performs as well as invasive angiography for detecting significant coronary lesions in the majority of children who have undergone the arterial switch procedure for TGA. CT also provides information on the underlying mechanism of coronary luminal narrowing.
我们研究了64层计算机断层扫描（CT）血管造影与有创血管造影相比，在评估大动脉转位（TGA）患儿动脉调转术（ASO）后再植冠状动脉方面的准确性。
评估再植冠状动脉的完整性对于TGA患儿ASO后的长期预后至关重要。非侵入性检查在检测显著冠状动脉病变方面准确性有限，在这种情况下通常需要进行有创冠状动脉造影。
130例连续接受TGA患儿ASO（年龄5.6±1.1岁）后，接受了传统有创冠状动脉造影和使用64层扫描仪的冠状动脉CT血管造影。通过与有创冠状动脉造影进行盲法比较，分析CT检测冠状动脉开口和近端节段显著冠状动脉狭窄（直径减少>30%）以及冠状动脉其他异常的能力。
130例患者中有126例（97%）的CT可进行全面评估，从而能够评估所有冠状动脉的开口和近端节段。CT正确检测出了有创冠状动脉造影确定有显著冠状动脉病变的所有12例患者（9.2%），其敏感性、特异性和阴性预测值均为100%。此外，CT显示6例患者有非显著冠状动脉病变（管腔狭窄<30%），并能够确定冠状动脉管腔狭窄的潜在原因，例如再植冠状动脉因其与相邻大血管的解剖关系而受到的拉伸或压迫。
对于大多数接受TGA动脉调转术的儿童，64层CT冠状动脉造影在检测显著冠状动脉病变方面与有创血管造影表现相当。CT还能提供冠状动脉管腔狭窄潜在机制的信息。
