Michalak Krzysztof W, Moll Jadwiga A, Moll Maciej, Mludzik Katarzyna, Moll Jacek J
Polish Mother's Memorial Hospital, Research Institute, Łódź, Poland.
World J Pediatr Congenit Heart Surg. 2010 Apr;1(1):51-8. doi: 10.1177/2150135110361361.
Anatomical correction is a procedure of choice for transposition of the great arteries (TGA) in neonates. During surgery, the aorta and pulmonary artery are switched-the native pulmonary valve becomes the neoaortic valve. The fate of this valve remains uncertain. Many reports suggest that its ability to function worsens with time after surgery. Of 519 patients with TGA operated on between 1991 and 2008, 161 met inclusion criteria for this retrospective study and were followed 10 years or more to assess neoaortic valve regurgitation (NeoAR) occurrence and development and to estimate potential risk factors. The subjects were divided into 2 groups: group 1 (simple TGA) and group 2 (TGA + ventricle septal defect). Within the analyzed group, the frequency of significant regurgitation increased from 9% 1 year after the operation to 47% at the most recent follow-up. No severe regurgitation necessitating reoperation was observed. Analysis of potential risk factors revealed that pulmonary/aortic valve diameter discrepancy and nonfacing commissures were associated with increased risk of development of neoaortic insufficiency. NeoAR arises and develops over time after correction of the defect. No hemodynamic repercussions necessitating cardiac surgical interventions were observed. The majority of insufficiencies are detected between 2 and 6 years after surgery. The degree of incompetence is usually mild and increases during follow-up by about 0.5 or 1 degree. The risk factors for NeoAR appearance are pulmonary artery/aortic annulus discrepancy and nonfacing commissures.
解剖矫正术是新生儿大动脉转位（TGA）的首选治疗方法。手术过程中，主动脉和肺动脉进行交换——原来的肺动脉瓣成为新主动脉瓣。该瓣膜的转归尚不确定。许多报告表明，术后随着时间推移其功能会恶化。在1991年至2008年接受手术的519例TGA患者中，161例符合本回顾性研究的纳入标准，并随访10年或更长时间，以评估新主动脉瓣反流（NeoAR）的发生和发展情况，并估计潜在危险因素。研究对象分为两组：第1组（单纯TGA）和第2组（TGA + 室间隔缺损）。在分析的组内，严重反流的发生率从术后1年的9%增加到最近一次随访时的47%。未观察到需要再次手术的严重反流情况。对潜在危险因素的分析显示，肺动脉/主动脉瓣直径差异和非对合交界与新主动脉瓣关闭不全发生风险增加有关。NeoAR在缺损矫正术后随时间出现并发展。未观察到需要心脏外科干预的血流动力学影响。大多数关闭不全在术后2至6年被发现。关闭不全程度通常较轻，随访期间增加约0.5或1度。NeoAR出现的危险因素是肺动脉/主动脉瓣环差异和非对合交界。
