Calderon Kylie, Sodhi Aparna, Johnson Ethan M I, Markl Michael, Robinson Joshua D, Rigsby Cynthia K
Duke University, 40 Duke Medicine Circle, 124 Davison Building, Durham, Durham, NC, 27710, USA.
Lurie Children's Hospital, Chicago, USA.
Pediatr Radiol. 2025 Feb;55(2):280-296. doi: 10.1007/s00247-024-06110-4. Epub 2024 Dec 20.
Pulmonary artery stenosis, neoaortic dilatation, and neoaortic valve insufficiency are among the most frequent complications of the arterial switch operation for repair of dextro-transposition of the great arteries (d-TGA). It remains difficult to predict which patients will require great arterial reintervention.
We aimed to characterize hemodynamics within the great arteries using 4D flow MRI in patients with d-TGA after the arterial switch operation.
Patients with d-TGA after the arterial switch operation and controls with normal cardiac anatomy who underwent 4D flow MRI between 2012 and 2024 were included in this IRB-approved retrospective cohort study. Controls included patients undergoing MRI for other indications who consented or assented to the addition of a 4D flow sequence, as well as patients who underwent clinically indicated 4D flow MRI and were found to have normal cardiac anatomy and function. Velocity, stasis, kinetic energy, energy loss, wall shear stress, and pulse wave velocity were quantified in the aorta and pulmonary arteries. To compare each parameter between d-TGA patients and controls, unpaired t-tests were used for normally distributed data and Mann-Whitney tests for non-normal data. P < 0.05 was significant.
Patients with d-TGA after the arterial switch operation (15.7 years ± 2.4, 2 females) demonstrated significantly higher maximum and mean velocity, maximum and mean kinetic energy, energy loss, and maximum and mean wall shear stress within the pulmonary arteries (P < 0.0001 for all parameters) compared with age-matched controls (15.5 years ± 2.4, 14 females). Aortic maximum (P = 0.001) and mean (P = 0.048) velocity, maximum (P = 0.0008) and mean (P = 0.003) kinetic energy, energy loss (P < 0.0001), maximum wall shear stress in five of six regions (range P < 0.0001 to P = 0.002), and mean wall shear stress in three regions (range P = 0.005 to P = 0.03) were significantly higher in patients with d-TGA after the arterial switch operation patients compared with age-matched controls.
Patients with d-TGA after the arterial switch operation demonstrate hemodynamic abnormalities within the great arteries, which may provide insight into the mechanisms underlying postoperative consequences of the arterial switch operation.
肺动脉狭窄、新主动脉扩张和新主动脉瓣关闭不全是大动脉转位（d-TGA）修复动脉调转手术最常见的并发症。预测哪些患者需要再次进行大动脉干预仍然很困难。
我们旨在使用4D流动磁共振成像（MRI）对动脉调转手术后d-TGA患者的大动脉内血流动力学进行特征描述。
本项经机构审查委员会批准的回顾性队列研究纳入了2012年至2024年间接受4D流动MRI检查的动脉调转手术后d-TGA患者以及心脏解剖结构正常的对照者。对照者包括因其他适应症接受MRI检查并同意或赞成增加4D流动序列的患者，以及接受临床指征性4D流动MRI检查且心脏解剖结构和功能正常的患者。对主动脉和肺动脉中的速度、血流淤滞、动能、能量损失、壁面剪应力和脉搏波速度进行了量化。为比较d-TGA患者和对照者之间的各项参数，对正态分布数据采用非配对t检验，对非正态数据采用曼-惠特尼检验。P < 0.05具有统计学意义。
动脉调转手术后的d-TGA患者（15.7岁±2.4岁，2名女性）与年龄匹配的对照者（15.5岁±2.4岁，14名女性）相比，肺动脉内的最大和平均速度、最大和平均动能、能量损失以及最大和平均壁面剪应力均显著更高（所有参数P < 0.0001）。动脉调转手术后的d-TGA患者的主动脉最大速度（P = 0.001）和平均速度（P = 0.048）、最大动能（P = 0.0008）和平均动能（P = 0.003）、能量损失（P < 0.0001）、六个区域中的五个区域的最大壁面剪应力（范围为P < 0.0001至P = 0.002）以及三个区域中的平均壁面剪应力（范围为P = 0.005至P = 0.03）均显著高于年龄匹配的对照者。
动脉调转手术后的d-TGA患者在大动脉内表现出血流动力学异常，这可能有助于深入了解动脉调转手术术后后果的潜在机制。
