Department of Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.
Department of Cardiac Surgery, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.
Cardiol Young. 2023 Sep;33(9):1550-1555. doi: 10.1017/S1047951122002670. Epub 2022 Aug 30.
Pulmonary stenosis is one of the most common complications in patients with transposition of the great arteries after the arterial switch operation. The reason for this is multifactorial and related to the anterior shift of the pulmonary trunk during the LeCompte manoeuvre, the complex suture line required to fill the gaps after harvesting the coronary arteries, and the need for patch implantation to maintain a tensionless anastomosis.We reviewed all patients with transposition of the great arteries operated on at our institute between 1991 and 2020 to establish the frequency of pulmonary stenosis during post-operative follow-up, reinterventions, and reoperations related to pulmonary stenosis and its potential risk factors.During the analysed period, we performed 848 arterial switch operations for simple and complex cases of transposition of the great arteries. The overall early mortality was 6.96%, and the late mortality was 2.53%. Among all study groups, 243 (28.66%) patients developed mild pulmonary stenosis, 43 patients (5.07%) developed moderate, and 45 patients (5.31%) developed severe pulmonary stenosis. During follow-up, 21 patients required interventions related to pulmonary stenosis. Pulmonary reconstruction with patches, aortic arch anomalies, and ventricular septal defects associated with transposition of the great arteries were significant risk factors. Nine patients required reoperation because of pulmonary artery stenosis with patch reconstruction of the pulmonary artery, aortic arch anomalies, and aortic cross-clamping time, increasing the risk of reoperation.Pulmonary stenosis in patients with transposition of the great arteries after the arterial switch operation is a common complication. If significant, it occurs early after surgery and is the most frequent reason for post-operative interventions and reoperations.
肺动脉瓣狭窄是大动脉转位患者在接受大动脉调转手术后最常见的并发症之一。造成这种情况的原因是多方面的，与 LeCompte 操作中肺动脉干的前移位、在采集冠状动脉后需要进行复杂的缝合线填充以及需要进行补丁植入以维持无张力吻合有关。我们回顾了 1991 年至 2020 年期间在我们研究所接受大动脉转位手术的所有患者，以确定术后随访期间、与肺动脉瓣狭窄相关的再干预和再次手术的频率及其潜在的危险因素。在分析期间，我们对简单和复杂的大动脉转位病例进行了 848 例大动脉调转手术。总的早期死亡率为 6.96%，晚期死亡率为 2.53%。在所有研究组中，243 名（28.66%）患者出现轻度肺动脉瓣狭窄，43 名（5.07%）患者出现中度肺动脉瓣狭窄，45 名（5.31%）患者出现重度肺动脉瓣狭窄。在随访期间，21 名患者需要进行与肺动脉瓣狭窄相关的干预。带补丁的肺动脉重建、主动脉弓异常和与大动脉转位相关的室间隔缺损是显著的危险因素。9 名患者因肺动脉瓣狭窄伴肺动脉带补丁重建、主动脉弓异常和主动脉阻断时间而需要再次手术，增加了再次手术的风险。大动脉转位患者在接受大动脉调转手术后发生肺动脉瓣狭窄是一种常见的并发症。如果狭窄严重，通常在手术后早期发生，是术后干预和再次手术最常见的原因。
