Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; The Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, the Netherlands.
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
Ann Thorac Surg. 2013 Oct;96(4):1390-1397. doi: 10.1016/j.athoracsur.2013.05.004. Epub 2013 Jul 16.
The arterial switch operation is the current treatment for transposition of the great arteries. Long-term outcome mainly depends on the patency of the transferred coronary arteries. This study assessed the presence of abnormal coronary findings and neoaortic root dilation late after arterial switch operation.
In 30 adult patients after arterial switch operation (22 men, 22 ± 3 years), computed tomography angiography was performed to assess the coronary anatomy and abnormal coronary findings, defined as significant stenosis, interarterial coronary course, and acute angled coronary origins. Neoaortic root dimensions and coronary takeoff height were also assessed.
The most common coronary anatomy pattern was found in 24 of 30 patients. Variant anatomy patterns were seen in 6 patients (5 with aberrant circumflex artery, 1 with a single ostium). The prevalence of abnormal coronary findings was higher in patients with variant coronary pattern as compared with patients with common coronary pattern (100% and 29%, respectively; p = 0.003). In particular, an acute angle of the coronary origin was frequently observed. In patients with an acute angle, larger dimensions of the aortic annulus (p = 0.016) and the sinus of Valsalva (p = 0.002) were observed. Moreover, a higher takeoff of the right (p = 0.030) and left (p = 0.002) coronary ostium was noted in patients with acute angles.
Abnormal coronary findings were frequently observed in adult patients after arterial switch operation, especially in patients with a variant coronary anatomy pattern. Neoaortic root dilation and a higher coronary takeoff may explain part of the pathophysiology. Long-term follow-up is needed to determine the clinical significance of these findings.
动脉调转术是当前治疗大动脉转位的方法。长期疗效主要取决于转位后的冠状动脉通畅性。本研究评估了大动脉调转术后患者的冠状动脉异常和新主动脉根部扩张情况。
30 名大动脉调转术后的成年患者（22 名男性，22 ± 3 岁）接受了计算机断层血管造影检查，以评估冠状动脉解剖结构和异常冠状动脉发现，包括严重狭窄、冠状动脉间交通和冠状动脉起源锐角。同时评估新主动脉根部直径和冠状动脉起始高度。
24 名患者的冠状动脉解剖结构符合常见类型，6 名患者（5 名存在回旋支异常，1 名存在单支冠状动脉开口）存在变异类型。变异型冠状动脉解剖结构患者的异常冠状动脉发现发生率高于常见型患者（100%和 29%；p = 0.003）。特别是，锐角起源的冠状动脉更为常见。锐角起源的患者主动脉瓣环（p = 0.016）和主动脉窦（p = 0.002）直径更大。此外，锐角起源的患者右冠状动脉（p = 0.030）和左冠状动脉（p = 0.002）的起始高度更高。
动脉调转术后的成年患者常存在异常冠状动脉发现，尤其是在冠状动脉解剖结构变异的患者中。新主动脉根部扩张和冠状动脉起始高度增加可能部分解释了其发病机制。需要长期随访来确定这些发现的临床意义。
