Shepard Charles W, Germanakis Ioannis, White Matthew T, Powell Andrew J, Co-Vu Jennifer, Geva Tal
From the The Children's Heart Clinic, Minneapolis, MN (C.W.S.); Department of Pediatrics, University of Crete, Greece (I.G.); Department of Cardiology, Boston Children's Hospital, MA; and Department of Pediatrics, Harvard Medical School, Boston, MA (M.T.W., A.J.P., T.G.); Division of Pediatric Cardiology, University of Florida, Gainesville (J.C.-V.).
Circ Cardiovasc Imaging. 2016 Sep;9(9). doi: 10.1161/CIRCIMAGING.116.004618.
Despite its robust diagnostic capabilities in adolescents and adult patients after the arterial switch operation, little information is available on the cardiovascular magnetic resonance findings in this population.
The cardiovascular magnetic resonance findings of 220 consecutive patients evaluated in our center were retrospectively reviewed (median age at cardiovascular magnetic resonance, 15.4 years; 66.8% male sex). Compared with published normal values, left and right ventricular end-diastolic volume z scores were mildly enlarged (0.48±1.76 and 0.33±1.5; P=0.0003 and 0.0038, respectively), with 26% of patients having left ventricular dilatation and 20% having right ventricular dilatation. Left ventricular dysfunction was present in 21.5% of patients (mild in most), and only 5.1% of patients had mild right ventricular dysfunction. Myocardial scar was found in 1.8% of patients. Dilatation of the neoaortic root was common (76%), and root z score increased at an average rate of 0.03 points per year. By multivariable analysis, neoaortic root dilatation was associated with worse neoaortic valve regurgitation (OR, 5.29; P=0.0016). The diameters of the thoracic aorta distal to the root were near-normal in most patients, whereas the neomain pulmonary artery was typically oval shaped with decreased anteroposterior and normal lateral diameters.
Although the majority of arterial switch operation patients have normal ventricular size and function and myocardial scar is rare, an important minority exhibits ventricular enlargement or dysfunction. Neoaortic root dilatation, which is present in most patients and progresses over time, is strongly associated with significant neoaortic valve regurgitation. The findings of this study provide reference values against which arterial switch operation patients can be compared with their peers.
尽管心血管磁共振成像在动脉调转术后青少年和成年患者中具有强大的诊断能力，但关于该人群心血管磁共振成像结果的信息却很少。
回顾性分析了在我们中心连续评估的220例患者的心血管磁共振成像结果（心血管磁共振成像时的中位年龄为15.4岁；男性占66.8%）。与已发表的正常值相比，左、右心室舒张末期容积z评分轻度增大（分别为0.48±1.76和0.33±1.5；P分别为0.0003和0.0038），26%的患者有左心室扩张，20%的患者有右心室扩张。21.5%的患者存在左心室功能障碍（大多数为轻度），只有5.1%的患者有轻度右心室功能障碍。1.8%的患者发现心肌瘢痕。新主动脉根部扩张很常见（76%），根部z评分平均每年增加0.03分。多变量分析显示，新主动脉根部扩张与更严重的新主动脉瓣反流相关（比值比，5.29；P = 0.0016）。大多数患者根部远端胸主动脉直径接近正常，而新主肺动脉通常呈椭圆形，前后径减小，横径正常。
尽管大多数动脉调转术患者的心室大小和功能正常，心肌瘢痕罕见，但仍有一小部分患者出现心室扩大或功能障碍。大多数患者存在且随时间进展的新主动脉根部扩张与严重的新主动脉瓣反流密切相关。本研究结果提供了参考值，可用于将动脉调转术患者与其同龄人进行比较。
