Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Division of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Interact Cardiovasc Thorac Surg. 2021 Jun 28;33(1):101-109. doi: 10.1093/icvts/ivab035.
To compare conventional procedures with the half-turned truncal switch operation (HTTSO) for the management of complete transposition of the great arteries with left ventricular outflow tract (LVOT) obstruction using time-resolved 3-dimensional magnetic resonance phase-contrast imaging.
We identified 2 cases that underwent the Rastelli procedure and one case that underwent the Réparation a l'étage ventriculaire before 2002 [conventional procedures group (group C)], and 16 cases of HTTSO that were performed between 2002 and 2020 [HTTSO group (group H)]. Postoperative haemodynamics were assessed using time-resolved 3-dimensional magnetic resonance phase-contrast imaging in cases in both groups.
The median follow-up period was 20.4 years in group C, and 6.1 years in group H. In group C, all 3 patients underwent reoperation because of postoperative right ventricular outflow tract obstruction and/or insufficiency. In addition, permanent pacemaker implantation was needed in 1 patient because of complete atrioventricular block complicated by ventricular septal defect enlargement. In group H, reoperation for LVOT/right ventricular outflow tract obstruction was not needed. A time-resolved 3-dimensional magnetic resonance phase-contrast imaging examination revealed high energy loss and wall shear stress in the winding LVOT in the group C. In contrast, low energy loss and wall shear stress, with straight and smooth LVOT, were identified in group H.
HTTSO was shown to be superior to conventional procedures because a straight and wide LVOT could be obtained. Therefore, HTTSO should be the first choice for complete transposition of the great arteries with LVOT obstruction.
使用时间分辨 3 维磁共振相位对比成像比较完全性大动脉转位合并左心室流出道（LVOT）梗阻的传统手术与半转身干切换手术（HTTSO）的治疗效果。
我们鉴定了 2002 年之前接受 Rastelli 手术的 2 例和接受 Réparation a l'étage ventriculaire 的 1 例（传统手术组，C 组），以及 2002 年至 2020 年期间行 HTTSO 的 16 例（HTTSO 组，H 组）。在两组患者中均使用时间分辨 3 维磁共振相位对比成像评估术后血流动力学。
C 组的中位随访时间为 20.4 年，H 组为 6.1 年。C 组 3 例患者均因术后右心室流出道梗阻和/或功能不全而再次手术。此外，1 例患者因并发室间隔缺损扩大的完全性房室传导阻滞需要植入永久性起搏器。H 组不需要进行 LVOT/右心室流出道梗阻的再次手术。时间分辨 3 维磁共振相位对比成像检查显示 C 组 LVOT 迂曲处能量损耗和壁面切应力较高。相比之下，H 组的 LVOT 较为直且光滑，能量损耗和壁面切应力较低。
HTTSO 优于传统手术，因为可以获得直而宽的 LVOT。因此，HTTSO 应成为合并 LVOT 梗阻的完全性大动脉转位的首选治疗方法。
