Abstract：
Background: Dextro transposition of the great arteries (d-TGA) is the most common critical congenital cardiac defect surgically treated in the neonatal period by arterial switch operation (ASO). Major aortopulmonary collaterals (MAPCAs) can be present in this population and may complicate the early postoperative period. Our aim was to review our institutional data and systematically review the available literature to provide further insight on the clinical significance of MAPCAs during the early postoperative course after ASO. Methods: This is a retrospective study of patients with simple d-TGA who underwent ASO between March 1998 and September 2020 at Boston Children\'s Hospital. The MEDLINE, Embase, and Cochrane databases were searched from inception to June 2020. Results: Of the 671 d-TGA patients who underwent ASO at our center, 13 (1.9%) were diagnosed with MAPCAs. Five were diagnosed before ASO, while eight were diagnosed after ASO. Of these, two patients required catheterization for MAPCAs coiling during the same hospitalization on the 2nd and 11th postoperative days. The systematic review retrieved a total of 34 articles after duplicates were removed. Finally, nine studies reporting on 23 patients were deemed eligible for our analysis. The average time to MAPCAs coiling was 12 days, while the mean hospital stay was 36 days. Conclusions: MAPCAs should be included in the differential diagnosis of ASO complicated by cardiac or respiratory failure, or pulmonary hemorrhage acutely postoperatively. Once managed, recovery of these patients is predictable, and mortality is low. Further studies investigating the diagnostic value of echocardiography and the long-term outcomes of these MAPCAs are necessary.
摘要：
背景：大动脉右旋转位（d-TGA）是新生儿期通过动脉转换手术（ASO）手术治疗的最常见的严重先天性心脏缺损。该人群中可能存在主要的主动脉肺侧支（MAPCAs），并可能使术后早期复杂化。我们的目的是回顾我们的机构数据并系统地回顾现有文献，以进一步了解ASO术后早期MAPCAs的临床意义。方法：这是一项回顾性研究，对1998年3月至2020年9月在波士顿儿童医院接受ASO的单纯d-TGA患者进行。MEDLINE,Embase,和Cochrane数据库从开始到2020年6月进行了搜索。结果：在我们中心接受ASO的671d-TGA患者中，13例（1.9%）被诊断为MAPCAs。五个在麻生之前被诊断出来，而8人在ASO后被诊断出来。其中,两名患者在术后第2天和第11天的同一住院期间需要导管插入以进行MAPCAs盘绕。删除重复项后，系统评价共检索到34篇文章。最后,纳入23例患者的9项研究被认为符合我们分析的条件.MAPCAs卷绕的平均时间为12天，而平均住院时间为36天。结论:ASO合并心力衰竭或呼吸衰竭的鉴别诊断应包括MAPCAs。或术后急性肺出血。一旦管理，这些患者的康复是可以预测的，死亡率很低。需要进一步研究超声心动图的诊断价值和这些MAPCA的长期结果。
