Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand.
Ann Thorac Surg. 2012 Dec;94(6):2084-90. doi: 10.1016/j.athoracsur.2012.07.013. Epub 2012 Sep 13.
Intramural coronary artery course (IMCA) is associated with an increased risk of coronary event and mortality after the arterial switch operation (ASO). We describe early and late outcomes at our institution from 1996 to 2006.
Operation notes for all patients who underwent ASO within 60 days of birth were reviewed, and those with IMCA were identified. Mortality and morbidity were obtained from discharge summary, predischarge electrocardiogram, and echocardiogram. Follow-up included clinical review, electrocardiogram, echocardiography, dobutamine stress echocardiography, and angiography.
Eighteen patients of 215 in the cohort (8.4%) had IMCA. Intramural coronary artery course was more common in patients from French Polynesia (6 of 17; 35.3% versus 12 of 198; 6.1%; p=0.001). Early mortality for patients with IMCA was 1 of 18 (5.6%) compared with 6 of 197 (3%) for those without IMCA (p=0.46). One IMCA patient was lost to follow-up. The remaining 16 are alive and asymptomatic. Of the 13 who underwent angiography, 2 had minor coronary artery stenoses at initial nonselective aortic root angiography. Both stenoses resolved at subsequent selective coronary angiography. None of the 11 who underwent dobutamine stress echocardiography had inducible ischemia.
We report a high prevalence of IMCA in an ASO population, particularly among patients referred from French Polynesia. Intramural coronary artery course was not a risk factor for mortality after ASO. Angiography demonstrated excellent short-term and long-term structural outcome for IMCA.
在动脉调转手术（ASO）后，心外膜冠状动脉走行（IMCA）与冠状动脉事件和死亡率增加相关。我们描述了 1996 年至 2006 年在我院的早期和晚期结果。
回顾了所有在出生后 60 天内接受 ASO 的患者的手术记录，并确定了存在 IMCA 的患者。死亡率和发病率通过出院总结、出院前心电图和超声心动图获得。随访包括临床复查、心电图、超声心动图、多巴酚丁胺负荷超声心动图和血管造影。
在 215 例队列患者中，有 18 例（8.4%）存在 IMCA。法属波利尼西亚患者中 IMCA 更为常见（17 例中的 6 例，35.3%，与 198 例中的 12 例，6.1%；p=0.001）。存在 IMCA 的患者的早期死亡率为 1 例（5.6%），而不存在 IMCA 的患者为 6 例（3%）（p=0.46）。1 例 IMCA 患者失访。其余 16 例患者存活且无症状。在接受血管造影的 13 例患者中，有 2 例初始非选择性主动脉根部血管造影时存在轻微冠状动脉狭窄。随后的选择性冠状动脉血管造影显示所有狭窄均消失。在接受多巴酚丁胺负荷超声心动图检查的 11 例患者中，均未发现可诱导的缺血。
我们报告了 ASO 患者中存在高比例的 IMCA，尤其是在来自法属波利尼西亚的患者中。IMCA 不是 ASO 后死亡率的危险因素。血管造影显示 IMCA 的短期和长期结构结果均良好。
