Canan Arzu, Ashwath Ravi, Agarwal Prachi P, François Christopher, Rajiah Prabhakar
From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa (R.A.); Department of Radiology, University of Michigan, Ann Arbor, Mich (P.P.A.); and Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (C.F., P.R.).
Radiographics. 2021 Mar-Apr;41(2):338-360. doi: 10.1148/rg.2021200069. Epub 2021 Jan 22.
Transposition of the great arteries (TGA) is a congenital conotruncal abnormality characterized by discordant connections between the ventricles and great arteries, with the aorta originating from the right ventricle (RV), and the pulmonary artery (PA) originating from the left ventricle (LV). The two main types of TGA are complete transposition or dextro-transposition of the great arteries (D-TGA), commonly referred to as d-loop, and congenitally corrected transposition (CCTGA), commonly referred to as l-loop or L-TGA. In D-TGA, the connections between the ventricles and atria are concordant, whereas in CCTGA they are discordant, with the left atrium connected to the RV, and the right atrium connected to the LV. D-TGA manifests during the neonatal period and can be surgically managed by atrial switch operation (AtrSO), arterial switch operation (ASO), Rastelli procedure, or Nikaidoh procedure. Arrhythmia, systemic ventricular dysfunction, baffle stenosis, and baffle leak are the common complications of AtrSO, whereas supravalvular pulmonary or branch PA stenosis, neoaortic dilatation, and coronary artery narrowing are the common complications of ASO. CCTGA may manifest late in life, even in adulthood. Surgeries for associated lesions such as tricuspid regurgitation, subpulmonic stenosis, and ventricular septal defect may be performed. A double-switch operation that includes both the atrial and arterial switch operations constitutes anatomic correction for CCTGA. Imaging plays an important role in the evaluation of TGA, both before and after surgery, for helping define the anatomy, quantify hemodynamics, and evaluate complications. Transthoracic echocardiography is the first-line imaging modality for presurgical planning in children with TGA. MRI provides comprehensive morphologic and functional information, particularly in adults after surgery. CT is performed when MRI is contraindicated or expected to generate artifacts. The authors review the imaging appearances of TGA, with a focus on pre- and postsurgical imaging. RSNA, 2021.
大动脉转位（TGA）是一种先天性圆锥动脉干异常，其特征为心室与大动脉之间连接不一致，主动脉起源于右心室（RV），肺动脉（PA）起源于左心室（LV）。TGA的两种主要类型是完全性大动脉转位或右位大动脉转位（D-TGA），通常称为d环，以及先天性矫正型大动脉转位（CCTGA），通常称为l环或L-TGA。在D-TGA中，心室与心房之间的连接是一致的，而在CCTGA中则不一致，左心房与右心室相连，右心房与左心室相连。D-TGA在新生儿期出现，可通过心房调转术（AtrSO）、动脉调转术（ASO）、Rastelli手术或Nikaidoh手术进行手术治疗。心律失常、体循环心室功能障碍、挡板狭窄和挡板渗漏是AtrSO的常见并发症，而瓣上肺动脉或分支肺动脉狭窄、新主动脉扩张和冠状动脉狭窄是ASO的常见并发症。CCTGA可能在生命后期出现，甚至在成年期。可对相关病变如三尖瓣反流、肺动脉瓣下狭窄和室间隔缺损进行手术。包括心房和动脉调转术的双调转手术构成了CCTGA的解剖学矫正。成像在TGA手术前后的评估中起着重要作用，有助于明确解剖结构、量化血流动力学并评估并发症。经胸超声心动图是TGA患儿术前规划的一线成像方式。MRI提供全面的形态和功能信息，尤其是在成人术后。当MRI禁忌或预计会产生伪影时，则进行CT检查。作者回顾了TGA的成像表现，重点是术前和术后成像。RSNA，2021年
