Pasquini L, Sanders S P, Parness I A, Wernovsky G, Mayer J E, Van der Velde M E, Spevak P J, Colan S D
Department of Cardiology, Harvard Medical School, Boston, Massachusetts.
J Am Coll Cardiol. 1994 Sep;24(3):763-8. doi: 10.1016/0735-1097(94)90026-4.
The reliability of two-dimensional echocardiography for determining the proximal coronary artery anatomy in d-loop transposition of the great arteries was investigated in 406 infants who underwent surgical repair at one institution.
The origin and proximal course of the main coronary arteries can affect the surgical results of the arterial switch operation. Preoperative determination of the coronary artery anatomy appears to be advantageous for the surgeon.
All infants with d-loop transposition who underwent a two-dimensional echocardiogram and primary surgical repair at our institution between 1987 and 1992 were identified, and the echocardiographic, operative and, when available, autopsy reports were reviewed for coronary artery anatomy, presence of a ventricular septal defect and the spatial relation between the arterial roots. The two-dimensional echocardiographic findings were compared with surgical or autopsy findings. The relation between proximal coronary artery anatomy and 1) a ventricular septal defect, and 2) the spatial orientation of the arterial roots was investigated. Twenty-seven infants diagnosed with an intramural coronary artery were not included because they are the subjects of another report.
Excluding intramural coronary artery patterns, 10 different types of coronary artery anatomy were seen in these 406 patients. The coronary arteries were imaged adequately in 387 (95%) of the 406 patients. The coronary artery anatomy was determined correctly by two-dimensional echocardiography in 369 (95.4%) of the 387 patients, with 18 errors in diagnosis. During the most recent 2.5 years, 193 (98.5%) of 196 patients were diagnosed correctly, with three diagnostic errors. Patients with a ventricular septal defect or side-by-side great arteries are more likely to have an unusual coronary pattern.
Echocardiography appears to be highly reliable for determining proximal coronary artery anatomy in d-loop transposition of the great arteries. An unusual coronary artery pattern is more likely in patients with side-by-side great arteries or posterior aorta or a ventricular septal defect, or both.
在一家机构接受手术修复的406例婴儿中，研究二维超声心动图确定大动脉d袢转位时近端冠状动脉解剖结构的可靠性。
主要冠状动脉的起源和近端走行可影响动脉调转手术的结果。术前确定冠状动脉解剖结构对外科医生似乎有利。
确定1987年至1992年间在我们机构接受二维超声心动图检查和初次手术修复的所有d袢转位婴儿，并查阅超声心动图、手术及（如有）尸检报告，以了解冠状动脉解剖结构、室间隔缺损的存在情况以及动脉根部的空间关系。将二维超声心动图检查结果与手术或尸检结果进行比较。研究近端冠状动脉解剖结构与1）室间隔缺损，以及2）动脉根部空间方向之间的关系。27例诊断为壁内冠状动脉的婴儿未纳入，因为他们是另一篇报告的研究对象。
排除壁内冠状动脉类型，这406例患者中可见10种不同类型的冠状动脉解剖结构。406例患者中有387例（95%）的冠状动脉成像良好。387例患者中，二维超声心动图正确确定冠状动脉解剖结构的有369例（95.4%），诊断错误18例。在最近2.5年中，196例患者中有193例（98.5%）诊断正确，诊断错误3例。有室间隔缺损或大动脉并列的患者更可能有异常的冠状动脉类型。
超声心动图在确定大动脉d袢转位时近端冠状动脉解剖结构方面似乎高度可靠。大动脉并列、后位主动脉或有室间隔缺损或两者皆有的患者更可能有异常的冠状动脉类型。
