Bonhoeffer P, Bonnet D, Piéchaud J F, Stümper O, Aggoun Y, Villain E, Kachaner J, Sidi D
Service de Cardiologie Pédiatrique, Hôpital Necker/Enfants-Malades, Paris, France.
J Am Coll Cardiol. 1997 Jan;29(1):202-6. doi: 10.1016/s0735-1097(96)00433-0.
We sought to describe a large series of coronary artery obstructions after the arterial switch operation for transposition of the great arteries and to discuss their clinical implications.
Aortic root angiography and myocardial perfusion imaging yield ambiguous results regarding the fate of the coronary artery anastomoses after the arterial switch operation. Late death related to coronary artery obstruction and growth of the translocated coronary arteries are of major concern in these patients.
Selective coronary artery angiography was performed prospectively in a total of 165 children.
A total of 12 coronary occlusions, 8 major stenoses, 6 minor stenoses of the left ostium and 4 stretchings of one coronary artery were identified. Obstructions were more frequent in types D and E (p < 0.001) of the Yacoub and Radley-Smith classification. Coronary obstruction was documented in all patients with electrocardiographic and ultrasound evidence of myocardial ischemia at time of study. Early postoperative ischemia did not predict coronary artery lesion if the patient had fully recovered. Persistent or delayed myocardial ischemia was highly predictive of coronary artery lesions. The incidence of coronary artery obstruction was very high (11 of 35) in patients operated on by a rapidly abandoned technique of single-orifice reimplantation of both coronary artery ostia.
Selective coronary angiography is the most accurate means to assess coronary artery obstruction after the arterial switch operation. Precise diagnosis of coronary artery lesions after this operation will help to elucidate the pathogenesis, develop adequate therapeutic strategies and might indicate how to prevent coronary complications after operation.
我们试图描述一大组大动脉转位动脉调转术后的冠状动脉梗阻情况，并讨论其临床意义。
主动脉根部血管造影和心肌灌注成像对于动脉调转术后冠状动脉吻合口的转归结果不明确。这些患者中，与冠状动脉梗阻相关的晚期死亡以及移位冠状动脉的生长是主要关注点。
前瞻性地对总共165名儿童进行了选择性冠状动脉造影。
共发现12处冠状动脉闭塞、8处严重狭窄、6处左冠状动脉口轻度狭窄以及1处冠状动脉拉长。在Yacoub和Radley-Smith分类的D型和E型中梗阻更为常见（p < 0.001）。在研究时所有有心电图和超声心动图证据显示心肌缺血的患者中均记录到冠状动脉梗阻。如果患者已完全康复，术后早期缺血并不能预测冠状动脉病变。持续性或延迟性心肌缺血高度提示冠状动脉病变。采用快速废弃的双冠状动脉口单孔再植技术进行手术的患者中冠状动脉梗阻发生率非常高（35例中有11例）。
选择性冠状动脉造影是评估动脉调转术后冠状动脉梗阻最准确的方法。该手术后冠状动脉病变的准确诊断将有助于阐明发病机制、制定适当的治疗策略，并可能提示如何预防术后冠状动脉并发症。
