Fricke Tyson A, Bulstra Anne Eva, Naimo Phillip S, Bullock Andrew, Robertson Terry, d'Udekem Yves, Brizard Christian P, Konstantinov Igor E
Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, Australia.
Princess Margaret Hospital for Children, Perth, Australia.
Ann Thorac Surg. 2016 Feb;101(2):725-9. doi: 10.1016/j.athoracsur.2015.08.090. Epub 2015 Nov 18.
Intramural coronary arteries may complicate coronary artery transfer during the arterial switch operation. We sought to determine the long-term outcomes of 28 patients with intramural coronary arteries who underwent an arterial switch operation at a single institution.
All patients who had intramural coronary arteries and underwent an arterial switch operation were identified from the hospital database and retrospectively reviewed.
From 1983 to 2009, 720 patients underwent an arterial switch operation at our institution. Twenty-eight (3.9%, 28 of 720) had intramural coronary arteries. Patients with intramural coronary arteries had transposition of the great arteries (96%, n = 27) or Taussig-Bing anomaly (4%, n = 1). There were no deaths. Follow-up was 100% complete. Mean follow-up was 16.3 years (median, 15.5 years; range, 5.6 to 26.9 years). No patient required reoperation or catheter reintervention on the coronary arteries. Freedom from reoperation was 93% at 10 years. No patient had more than mild aortic regurgitation at last follow-up. Nine (32%, 9 of 28) patients had coronary angiograms at median 16 months (range, 14 months to 17 years) after arterial switch operation. All patients were asymptomatic at the time of angiogram. One patient had mild stenosis of the circumflex coronary artery demonstrated on a routine coronary angiogram 14 months postoperatively. All 28 patients were asymptomatic and in New York Heart Association functional class I at last follow-up.
Patients with intramural coronary arteries are not at increased risk of death or coronary reinterventions and have excellent late outcomes after the arterial switch operation.
在动脉调转手术期间，壁内冠状动脉可能使冠状动脉移植变得复杂。我们试图确定在单一机构接受动脉调转手术的28例壁内冠状动脉患者的长期预后。
从医院数据库中识别出所有患有壁内冠状动脉并接受动脉调转手术的患者，并进行回顾性分析。
1983年至2009年，我院720例患者接受了动脉调转手术。其中28例（720例中的3.9%）患有壁内冠状动脉。壁内冠状动脉患者中，大动脉转位者占96%（n = 27），陶西格-宾畸形者占4%（n = 1）。无死亡病例。随访完整率为100%。平均随访时间为16.3年（中位数为15.5年；范围为5.6至26.9年）。无患者需要再次手术或进行冠状动脉导管介入治疗。10年时再次手术的自由度为93%。最后一次随访时，无患者出现超过轻度的主动脉瓣反流。9例（28例中的32%）患者在动脉调转手术后中位时间16个月（范围为14个月至17年）进行了冠状动脉造影。造影时所有患者均无症状。1例患者在术后14个月的常规冠状动脉造影中显示回旋支冠状动脉轻度狭窄。最后一次随访时，所有28例患者均无症状，纽约心脏协会心功能分级均为I级。
壁内冠状动脉患者死亡或再次进行冠状动脉介入治疗的风险未增加，动脉调转手术后远期预后良好。
