Yacoub Magdi H, Nagy Mohamed, Hosny Hatem, Afifi Ahmed, El Sawy Amr, Mahgoub Ahmed, Abdullah Hedaia, Romeih Soha, Shehata Mahmoud, Elafifi Abdelrahman
Cardiac Surgery Department, Aswan Heart Centre, Aswan, Egypt.
National Heart and Lung Institute, Imperial College London, London, United Kingdom.
Int J Cardiol Congenit Heart Dis. 2023 Sep 9;13:100471. doi: 10.1016/j.ijcchd.2023.100471. eCollection 2023 Sep.
To investigate the incidence, types and pathophysiology of criss-cross pattern of the proximal pulmonary arteries in common arterial trunk and its influence on management and outcomes.
Retrospective review of all patients with common arterial trunk who underwent Aswan Truncus Operation with regard to the origin and course of the proximal pulmonary artery branches as defined by 3D segmented models pre, immediately and 1 and 2 years after operation.
Between January 2019 and September 2022, 39 patients (19 males, aged 1-12 months) underwent the Aswan Truncus Operation. 18 patients (46%) had criss-cross arrangement of the proximal pulmonary artery. The mortality, ICU and hospital stay were not affected by the presence or absence of the criss-cross pattern. However, following operation in the criss-cross group, there was evidence of different degrees of kinking and twisting of the right pulmonary artery. This resulted in severe narrowing which required stenting or reoperation at different stages (1 during ICU stay and another after 1 year). Separate origin of the left pulmonary artery (Criss-cross Type 2) from a long stenotic ductus arteriosus required resection of the stenotic segment followed by anastomosis to the right pulmonary artery recreating a 60° angle of bifurcation.
Criss-cross pattern of proximal pulmonary arteries is common in patients with common arterial trunk. Pre-operative diagnosis and tailored approaches of repair are required to prevent late complications.
探讨共同动脉干近端肺动脉交叉模式的发生率、类型和病理生理学及其对治疗和预后的影响。
回顾性分析所有接受阿斯旺动脉干手术的共同动脉干患者，根据术前、术后即刻以及术后1年和2年的三维分段模型确定近端肺动脉分支的起源和走行。
2019年1月至2022年9月，39例患者（19例男性，年龄1至12个月）接受了阿斯旺动脉干手术。18例患者（46%）存在近端肺动脉交叉排列。交叉模式的有无不影响死亡率、重症监护病房（ICU）住院时间和住院时间。然而，在交叉组手术后，有证据表明右肺动脉存在不同程度的扭结和扭曲。这导致严重狭窄，需要在不同阶段进行支架置入或再次手术（1例在ICU住院期间，另1例在1年后）。左肺动脉单独起源（交叉2型）于长段狭窄的动脉导管，需要切除狭窄段，然后与右肺动脉吻合，重建60°的分叉角度。
共同动脉干患者近端肺动脉交叉模式常见。需要进行术前诊断并采取针对性的修复方法以预防晚期并发症。
