Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Eur J Cardiothorac Surg. 2010 Jun;37(6):1239-45. doi: 10.1016/j.ejcts.2009.12.032. Epub 2010 Feb 9.
The great arteries are in a non-spiral relationship in their transposition, even after arterial switch operation (ASO) with the Lecompte manoeuvre. We aim to restore the natural spiral great arteries and compare such ASO with conventional ASO with the Lecompte manoeuvre to clarify the functional implications of the spiral great arteries.
The early survivors of ASO (n=130) were included in this retrospective study. In spiral ASO (n=48), the main pulmonary artery ran alongside the aorta and gave rise to its branches posteriorly. Patients who underwent non-spiral ASO with the manoeuvre (n=82) were compared. The survival, re-operation-free ratio and the anatomic details for re-intervention after ASO were reviewed.
Average follow-up was 5.6 + or - 3.4 years (range: 2 months to 11 years). The estimated 10-year survival was similar (92.6% spiral vs 92.1% non-spiral, respectively). Significant pulmonary stenosis (PS) (>40mmHg) was noted in five (10.4%) in the spiral group and seven patients (9.7%) in the non-spiral (p=NS). The re-operation-free survival at 10 years was not significantly different (87.4% vs 90.1%). The reasons for re-operation were subvalvular PS (n=3) and residual defect (n=2) in the spiral group, while supravalvular PS (n=3), neo-aortic regurgitation (n=1) and aortic neo-coarctation (n=2) in the non-spiral group. Supravalvular PS and aortic neo-coarctation that occurred in the non-spiral group were not seen after spiral ASO.
Intermediate-term results of spiral ASO were satisfactory. Transposition is not a mere reversal of the great arteries; therefore, recognition of non-spiral relationship should be appreciated. Spiral reconstruction would be beneficial to reduce supravalvular PS and neo-aortic kinking. Further recognition of spiral function and refined modification might justify the application of spiral ASO in the future.
大动脉在转位中呈非螺旋关系，即使在进行动脉调转手术（ASO）并采用 Lecompte 操作后也是如此。我们旨在恢复自然螺旋状大动脉，并比较这种 ASO 与采用 Lecompte 操作的传统 ASO，以阐明大动脉螺旋的功能意义。
本回顾性研究纳入了 ASO 后的早期存活者（n=130）。在螺旋 ASO 中（n=48），主肺动脉与主动脉并行，并从其后方发出分支。将接受非螺旋 ASO 加该操作的患者（n=82）进行比较。回顾分析 ASO 后的生存率、无再手术率和再次干预的解剖细节。
平均随访时间为 5.6±3.4 年（范围：2 个月至 11 年）。估计 10 年生存率相似（螺旋组为 92.6%，非螺旋组为 92.1%）。螺旋组中有 5 例（10.4%）存在显著的肺动脉瓣狭窄（PS）（>40mmHg），而非螺旋组中有 7 例（9.7%）（p=NS）。10 年无再手术生存率无显著差异（87.4%vs90.1%）。螺旋组再手术的原因是瓣下 PS（n=3）和残余缺陷（n=2），而非螺旋组是瓣上 PS（n=3）、新主动脉瓣反流（n=1）和主动脉新缩窄（n=2）。非螺旋组中出现的瓣上 PS 和主动脉新缩窄在螺旋 ASO 后并未出现。
中期螺旋 ASO 结果令人满意。转位不仅仅是大动脉的反转；因此，应认识到非螺旋关系。螺旋重建有利于减少瓣上 PS 和新主动脉扭曲。进一步认识螺旋功能并进行精细修正可能证明在未来应用螺旋 ASO 的合理性。
