Department of Cardio-thoracic Surgery, 6993Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Adult Congenital Cardiology, 6993Erasmus University Medical Center, Rotterdam, the Netherlands.
World J Pediatr Congenit Heart Surg. 2021 Mar;12(2):230-233. doi: 10.1177/2150135120976135.
During unifocalization procedures for pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries, collateral arteries are either ligated or detached. Not much is known of the fate of the remaining arterial origins in the long term. Available computed tomography (CT) or magnetic resonance (MR) imaging of the intrathoracic arteries was examined to investigate possible abnormalities at the former position of the collateral arteries as well as ascending aortic diameters.
From 1989 to 2018, we performed 66 unifocalization procedures in 39 patients. One hundred and twenty-nine collateral arteries were ligated or detached. In 52% (15) of the surviving patients (with a total of 55 ligated or detached collaterals), sufficient imaging of the thoracic aorta from CT (11) and/or MR (9) was available for evaluation.
The median interval between unifocalization procedure and imaging was 15 years (interquartile range [IQR]: 9-19 years). In 93% (14) of the scanned patients, 18 blunt ends were detected at the location of a former collateral artery. No aneurysm formation of the descending aorta was observed. The median diameter of the ascending aorta was 35 mm (IQR: 31-40 mm). During follow-up, no aortic dissection or rupture occurred.
Aortic imaging late after unifocalization showed abnormalities in 93% of the scanned patients. Abnormalities consisted mostly of blunt ends of the former collateral artery. We recommend to include routine imaging of the aorta during late follow-up to detect eventual future abnormalities and monitor aortic diameters. Ascending aortic diameters showed slight dilatation with no clinical implications so far.
在肺动脉闭锁伴室间隔缺损和主肺动脉侧支动脉的单病灶化手术中，侧支动脉要么被结扎要么被切断。对于长期内剩余动脉起源的命运，我们知之甚少。检查了可用的胸部动脉计算机断层扫描（CT）或磁共振成像（MR），以研究前侧支动脉位置和升主动脉直径可能存在的异常。
1989 年至 2018 年，我们对 39 名患者进行了 66 次单病灶化手术。结扎或切断了 129 条侧支动脉。在 52%（15 名）的存活患者（总共结扎或切断了 55 条侧支动脉）中，有足够的 CT（11 例）和/或 MR（9 例）图像可用于评估胸主动脉。
单病灶化手术和影像学检查之间的中位数间隔为 15 年（四分位距[IQR]：9-19 年）。在 93%（14 例）扫描的患者中，在以前的侧支动脉位置发现了 18 个钝端。未观察到降主动脉动脉瘤形成。升主动脉的中位数直径为 35 毫米（IQR：31-40 毫米）。在随访期间，没有发生主动脉夹层或破裂。
单病灶化手术后的晚期主动脉影像学检查显示 93%的扫描患者存在异常。异常主要由以前的侧支动脉的钝端组成。我们建议在晚期随访中常规进行主动脉成像，以发现未来可能存在的异常并监测主动脉直径。升主动脉直径稍有扩张，但迄今无临床意义。
