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[大动脉转位患者的术前和术后影像学检查]

[Preoperative and postoperative imaging in patients with transposition of the great arteries].

作者信息

Gutberlet M, Hoffmann J, Künzel E, Fleischer A, Sarikouch S, Beerbaum P, Lehmkuhl L, Andres C, Lurz P, Kostelka M, Abdul-Khaliq H, Dähnert I, Grothoff M

机构信息

Universitätsklinikum Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland.

出版信息

Radiologe. 2011 Jan;51(1):15-22. doi: 10.1007/s00117-010-1996-7.

Abstract

Transposition of the great arteries (TGA) is a rare disease representing not more than 3-5% of all congenital heart diseases. TGA is a cardiac anomaly in which the aorta arises entirely or largely from the morphological right ventricle and the pulmonary artery from the morphological left ventricle. This is called a ventriculo-arterial discordant connection and when accompanied by an atrio-ventricular concordant connection it is called a complete or D-transposition (D-TGA). The terms congenitally corrected TGA (ccTGA) or L-TGA describe an atrio-ventricular discordant connection. In D-TGA survival can only be achieved if additional shunting is simultaneously present, which possibly has to be created post-natal by the so-called Rashkind maneuver.Nowadays, an early anatomic correction using the arterial switch operation is the treatment of choice. Up to the 1980s, an atrial switch operation according to Senning/Mustard was performed. Apart from echocardiography the imaging modality of choice is usually MRI to assess the complex postoperative anatomy, viability of the myocardium and to perform a volumetric and functional assessment, including MR flow measurements. Multidetector computed tomography (MDCT) is used if there are contraindications to MRI or if an assessment of cardiac and especially coronary anatomy is the main interest.

摘要

大动脉转位(TGA)是一种罕见疾病,在所有先天性心脏病中所占比例不超过3%至5%。TGA是一种心脏异常,其中主动脉完全或大部分起源于形态学上的右心室,而肺动脉起源于形态学上的左心室。这被称为心室-动脉不一致连接,当伴有房室一致连接时,称为完全性或D型转位(D-TGA)。术语先天性矫正型TGA(ccTGA)或L-TGA描述的是房室不一致连接。在D-TGA中,只有同时存在额外的分流才能实现存活,这可能需要在出生后通过所谓的拉什金德操作来建立。如今,采用动脉调转术进行早期解剖矫正成为首选治疗方法。直到20世纪80年代,一直采用森宁/马斯塔德心房调转术。除超声心动图外,通常选择的成像方式是MRI,用于评估复杂的术后解剖结构、心肌活力,并进行容积和功能评估,包括MR血流测量。如果存在MRI禁忌证或主要关注心脏尤其是冠状动脉解剖结构的评估,则使用多排螺旋计算机断层扫描(MDCT)。

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