小儿大动脉转位患者动脉调转术后肺动脉分叉角移位与对侧狭窄的相关性
Association of pulmonary artery bifurcation angle shift with contralateral stenosis after post-arterial switch in the pediatric transposition of great artery patients.
作者信息
Seripanu Panupong, Srisuwan Tanop, Pongprot Yupada, Sittiwangkul Rekwan, Phanacharoensawad Thanaporn, Wongyikul Pakpoom, Phinyo Phichayut, Saengsin Kwannapas
机构信息
Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
出版信息
PLoS One. 2025 Jun 20;20(6):e0325206. doi: 10.1371/journal.pone.0325206. eCollection 2025.
BACKGROUND
The arterial switch operation (ASO) is the standard surgical treatment for transposition of the great arteries (TGA). Postoperative complications such as branch pulmonary artery (PA) stenosis are commonly observed. This study aimed to investigate the possible potential anatomical mechanisms contributing to isolated branch PA stenosis using cardiac computed tomography (CCT).
METHODS
A retrospective, single-center study was conducted on pediatric patients under 18 years of age diagnosed with TGA, with or without ventricular septal defect (VSD), who underwent ASO and cardiac CCT between January 2004 and October 2022. Baseline characteristics, echocardiographic data, and CCT findings were compared between patients with and without isolated branch PA stenosis. Special attention was given to the angle between the PA bifurcation and the ascending aorta (AAO).
RESULTS
Among 30 patients enrolled, 46.67% (14/30) had isolated branch PA stenosis, while 53.33% (16/30) had no stenosis. Baseline and echocardiographic variables showed no significant differences between groups, except for the PA bifurcation angle relative to the AAO. Patients with isolated right PA (RPA) stenosis demonstrated significantly greater leftward angulation (median angle: 25° [IQR: 24, 30]) compared to the no-stenosis group (median angle: -2° [IQR: -8, 6.5]). Similarly, isolated left PA (LPA) stenosis was associated with greater rightward angulation (median angle: -22° [IQR: -32, -20]) compared to the no-stenosis group (P = 0.042).
CONCLUSION
Alterations in the PA bifurcation angle relative to the AAO may contribute to the development of isolated branch PA stenosis following ASO. Preoperative planning to optimize the PA bifurcation angle to within ±20 degrees may help reduce the risk of postoperative stenosis. A larger study incorporating advanced cardiac imaging into routine ASO follow-up is warranted.
背景
动脉调转术（ASO）是大动脉转位（TGA）的标准外科治疗方法。术后常见并发症如分支肺动脉（PA）狭窄。本研究旨在利用心脏计算机断层扫描（CCT）探究导致孤立性分支PA狭窄的可能潜在解剖学机制。
方法
对2004年1月至2022年10月期间接受ASO和心脏CCT检查的18岁以下诊断为TGA的儿科患者进行回顾性单中心研究，这些患者伴有或不伴有室间隔缺损（VSD）。比较有和没有孤立性分支PA狭窄的患者的基线特征、超声心动图数据和CCT结果。特别关注PA分叉与升主动脉（AAO）之间的夹角。
结果
在纳入的30例患者中，46.67%（14/30）有孤立性分支PA狭窄，而53.33%（16/30）无狭窄。除PA相对于AAO的分叉角度外, 基线和超声心动图变量在两组之间无显著差异。与无狭窄组（中位角度：-2°[IQR：-8, 6.5]）相比，孤立性右PA（RPA）狭窄患者表现出明显更大的向左成角（中位角度：25°[IQR：24, 30]）。同样，与无狭窄组相比，孤立性左PA（LPA）狭窄与更大的向右成角相关（中位角度：-22°[IQR：-32, -20]）（P = 0.042）。
结论
PA相对于AAO的分叉角度改变可能导致ASO术后孤立性分支PA狭窄的发生。术前计划将PA分叉角度优化至±20度以内可能有助于降低术后狭窄风险。有必要开展一项将先进心脏成像纳入常规ASO随访的更大规模研究。
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