左心室重塑在右型大动脉转位和左型大动脉转位患者中的分析。
An Analysis of Left Ventricular Retraining in Patients With Dextro- and Levo-Transposition of the Great Arteries.
机构信息
Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, California.
Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, California.
出版信息
Ann Thorac Surg. 2018 Mar;105(3):823-829. doi: 10.1016/j.athoracsur.2017.11.047. Epub 2017 Dec 20.
BACKGROUND
Patients with dextro (D)-transposition of the great arteries (TGA) who have undergone a previous atrial switch and for some patients with levo (L)-TGA (ie, no ventricular septal defect or outflow tract obstruction), the left ventricle (LV) may require retraining before late arterial switch. The purpose of this study was to analyze the results of LV retraining for these two entities.
METHODS
This was a retrospective review of 51 patients enrolled in an LV retraining program. There were 25 patients with D-TGA and 26 with L-TGA. The median age of the D-TGA patients was 15 years, and 22 of 25 were in New York Heart Association class III or IV. The median age of the L-TGA patients was 12 months, and 3 of 26 patients were in New York Heart Association class III or IV.
RESULTS
LV retraining was successful in 13 of the 25 patients (52%) with D-TGA, and 10 these 13 patients (77%) underwent successful late arterial switch. Of the 26 patients with L-TGA, LV retraining was successful in 24 (92%), and a double-switch operation was successful in 19 of 19 (100%) who subsequently underwent that procedure. A mathematical formula based on the incremental gain in left-to-right ventricular pressure ratio correctly predicted the success or failure in 94% of the patients.
CONCLUSIONS
The data demonstrate differences in the success of LV retraining and late arterial switch for D-TGA and L-TGA. We would propose that the LV retraining ratio may be useful in objectively selecting patients eligible for late arterial switch.
背景
患有右旋（D）-大动脉转位（TGA）的患者已经接受了先前的心房转换术，对于一些左旋（L）-TGA（即无室间隔缺损或流出道梗阻）的患者，左心室（LV）可能需要在晚期动脉转换前进行再训练。本研究的目的是分析这两种情况的 LV 再训练结果。
方法
这是一项 LV 再训练计划中 51 名患者的回顾性研究。其中 25 例为 D-TGA，26 例为 L-TGA。D-TGA 患者的中位年龄为 15 岁，25 例中有 22 例为纽约心脏协会（NYHA）III 级或 IV 级。L-TGA 患者的中位年龄为 12 个月，26 例中有 3 例为 NYHA III 级或 IV 级。
结果
25 例 D-TGA 患者中有 13 例（52%）LV 再训练成功，其中 13 例中有 10 例（77%）成功进行了晚期动脉转换。26 例 L-TGA 患者中，24 例（92%）LV 再训练成功，随后 19 例（100%）接受双开关手术的患者中，19 例手术成功。基于左心室与右心室压力比的增量增益的数学公式正确预测了 94%的患者的成功或失败。
结论
这些数据表明 D-TGA 和 L-TGA 的 LV 再训练和晚期动脉转换的成功率存在差异。我们建议 LV 再训练比可能有助于客观选择适合晚期动脉转换的患者。
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