Abstract：
BACKGROUND: The arterial switch operation (ASO) is the preferred treatment for d-transposition of the great arteries (TGA). Freedom from reintervention is mainly determined by the performance of the arterial outflow tracts, with variable incidence of pulmonary artery stenosis (PAS), possibly related to aspects of surgical technique. This pilot study attempts to describe pulmonary artery (PA) configuration through several measurements using three-dimensional data from cardiac magnetic resonance (CMR) imaging and assesses whether PA configuration is associated with PAS.
METHODS: A retrospective, single-centre analysis of paediatric patients undergoing CMR after ASO. The geometry of the pulmonary arteries was compared between patients with and without PAS as judged by the CMR report.
RESULTS: Among all patients (n = 612) after ASO, 45 patients underwent CMR at a median age of 10 years (3.5-13). Twenty-two (57.9%) had PAS, categorized as mild (n = 1), moderate (n = 19) or severe (n = 2). Eighteen had stenosis on PA branches. Four had MPA stenosis. Comparison between groups with and without PAS revealed no significant differences in neo-aortic to pulmonary angle, MPA to LPA/RPA angle, or bifurcation angle. There was a significant difference in cranial displacement, with more cranial displacement in the group without PAS. However, this group was older, 10.8 (7.3-14.3) years compared to those with PAS, 6.8 (1.5-12.1).
CONCLUSIONS: The spectrum of PAS after ASO is heterogenous. This study shows the feasibility of measuring PA configuration in three planes on CMR. There is no correlation between PA configuration and PAS. Therefore, other mechanisms are probably responsible for the occurrence of PAS, rather than the configuration on itself. Further multicentric studies are warranted to confirm the suggested measuring method and assessing the associations with PAS, to eventually advise surgical methodology.
METHODS: A retrospective, single-centre analysis of paediatric patients undergoing CMR after ASO. The geometry of the pulmonary arteries was compared between patients with and without PAS as judged by the CMR report.
RESULTS: Among all patients (n = 612) after ASO, 45 patients underwent CMR at a median age of 10 years (3.5-13). Twenty-two (57.9%) had PAS, categorized as mild (n = 1), moderate (n = 19) or severe (n = 2). Eighteen had stenosis on PA branches. Four had MPA stenosis. Comparison between groups with and without PAS revealed no significant differences in neo-aortic to pulmonary angle, MPA to LPA/RPA angle, or bifurcation angle. There was a significant difference in cranial displacement, with more cranial displacement in the group without PAS. However, this group was older, 10.8 (7.3-14.3) years compared to those with PAS, 6.8 (1.5-12.1).
CONCLUSIONS: The spectrum of PAS after ASO is heterogenous. This study shows the feasibility of measuring PA configuration in three planes on CMR. There is no correlation between PA configuration and PAS. Therefore, other mechanisms are probably responsible for the occurrence of PAS, rather than the configuration on itself. Further multicentric studies are warranted to confirm the suggested measuring method and assessing the associations with PAS, to eventually advise surgical methodology.
摘要：
背景：动脉转换手术（ASO）是大动脉d转位（TGA）的首选治疗方法。再干预的自由度主要取决于动脉流出道的性能，肺动脉狭窄（PAS）的发生率不同，可能与手术技术有关。这项初步研究试图通过使用心脏磁共振（CMR）成像的三维数据进行多次测量来描述肺动脉（PA）配置，并评估PA配置是否与PAS相关。
方法：回顾性研究，ASO后接受CMR的儿科患者的单中心分析。根据CMR报告的判断，比较了有和没有PAS的患者的肺动脉几何形状。
结果：在ASO后的所有患者（n=612）中，45例患者在中位年龄为10岁（3.5-13）时接受了CMR。22人（57.9％）有PAS，归类为轻度（n=1），中度（n=19）或重度（n=2）。18位PA分支狭窄。4人患有MPA狭窄。有和没有PAS组之间的比较显示新主动脉到肺的角度没有显着差异，MPA到LPA/RPA角度,或分叉角。颅骨位移有显着差异，无PAS组颅骨移位较多。然而,这个群体年龄更大，与考绩制度相比，10.8(7.3-14.3)年，6.8(1.5-12.1)。
结论：ASO后的PAS谱是异质的。这项研究表明了在CMR上三个平面上测量PA配置的可行性。PA配置和PAS之间没有相关性。因此,其他机制可能是PAS发生的原因，而不是本身的配置。需要进一步的多中心研究来确认建议的测量方法并评估与PAS的关联。最终建议手术方法。
方法：回顾性研究，ASO后接受CMR的儿科患者的单中心分析。根据CMR报告的判断，比较了有和没有PAS的患者的肺动脉几何形状。
结果：在ASO后的所有患者（n=612）中，45例患者在中位年龄为10岁（3.5-13）时接受了CMR。22人（57.9％）有PAS，归类为轻度（n=1），中度（n=19）或重度（n=2）。18位PA分支狭窄。4人患有MPA狭窄。有和没有PAS组之间的比较显示新主动脉到肺的角度没有显着差异，MPA到LPA/RPA角度,或分叉角。颅骨位移有显着差异，无PAS组颅骨移位较多。然而,这个群体年龄更大，与考绩制度相比，10.8(7.3-14.3)年，6.8(1.5-12.1)。
结论：ASO后的PAS谱是异质的。这项研究表明了在CMR上三个平面上测量PA配置的可行性。PA配置和PAS之间没有相关性。因此,其他机制可能是PAS发生的原因，而不是本身的配置。需要进一步的多中心研究来确认建议的测量方法并评估与PAS的关联。最终建议手术方法。
