Breinholt John P, John Sheba
UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON, HOUSTON, TEXAS.
Methodist Debakey Cardiovasc J. 2019 Apr-Jun;15(2):133-137. doi: 10.14797/mdcj-15-2-133.
Dextro-transposition of the great arteries (d-TGA) is a lethal congenital heart defect in which the great arteries-the pulmonary artery and aorta-are transposed to create ventriculoarterial discordance. Corrective surgical interventions have resulted in significant improvements in morbidity and mortality for this once-fatal congenital heart defect. The initial palliative surgery for d-TGA was the atrial switch operation, which provided physiological correction. The Mustard and Senning "atrial switch" procedures, in which an atrial baffle is created to produce a discordant atrioventricular connection on the existing discordant ventriculoarterial connection, showed preliminary success for the correction of d-TGA. However, follow-up evaluations demonstrated increasing complications from the right ventricle utilized as a systemic ventricle, resulting in progressive right ventricular dysfunction. Thus, the search continued for an anatomical correction of d-TGA to return the great arteries to their normal ventricular connections. The arterial switch operation (ASO), though attempted and theorized by many, was first successfully performed by Dr. Jatene and colleagues in 1975. For ASO, the distal main pulmonary artery and the distal ascending aorta are transected and then anastomosed to their respective ventricles with relocation of the coronary arteries to the neoaorta. The ASO has replaced the atrial switch operation since the 1980s and is now the standard surgical correction for d-TGA. As more patients who have undergone ASO are living into adulthood, late complications of this procedure have become more evident. The most common late postoperative complications include coronary artery stenosis, neoaortic root dilation, neoaortic insufficiency, and neopulmonic stenosis. Adults who have undergone ASO in childhood will need follow-up with surveillance imaging and evaluation of new symptoms or declining function to prevent and manage late postoperative complications. This review describes the management strategies for common late complications in patients who have undergone ASO.
大动脉右位转位（d-TGA）是一种致命的先天性心脏缺陷，其中大动脉——肺动脉和主动脉——发生转位，导致心室动脉不协调。矫正性外科手术干预已使这种曾经致命的先天性心脏缺陷的发病率和死亡率有了显著改善。d-TGA的初始姑息性手术是心房调转术，它提供了生理矫正。Mustard和Senning“心房调转”手术，即创建一个心房挡板以在现有的不协调心室动脉连接上产生不协调的房室连接，在矫正d-TGA方面显示出初步成功。然而，随访评估显示，用作体循环心室的右心室并发症不断增加，导致右心室功能逐渐减退。因此，人们继续寻求对d-TGA进行解剖矫正，以使大动脉恢复到正常的心室连接。动脉调转术（ASO），尽管许多人尝试过并进行过理论探讨，但1975年由Jatene博士及其同事首次成功实施。对于ASO，将远端主肺动脉和远端升主动脉横断，然后将它们分别与各自的心室吻合，并将冠状动脉重新定位到新主动脉。自20世纪80年代以来，ASO已取代心房调转术，现在是d-TGA的标准外科矫正方法。随着越来越多接受ASO的患者活到成年，该手术的晚期并发症变得更加明显。最常见的术后晚期并发症包括冠状动脉狭窄、新主动脉根部扩张、新主动脉瓣关闭不全和新肺动脉狭窄。儿童期接受ASO治疗的成年人需要通过监测成像进行随访，并评估新出现的症状或功能下降情况，以预防和处理术后晚期并发症。本综述描述了接受ASO治疗的患者常见晚期并发症的管理策略。
