PDF(Pubmed)
Abstract：
Although there have been great improvements in the short- and medium-term outcomes of the arterial switch operation (ASO) for transposition of the great arteries (TGA), some complications including pulmonary artery stenosis, aortic valve insufficiency, and aortic root dilatation have also been reported. After ASO, the original pulmonary root and valve, which function in the systemic position as the neo-aortic root and valve respectively, are exposed to the systemic blood pressure, resulting in aortic root dilatation and valve insufficiency in some patients. One of the risk factors for these complications is a history of prior pulmonary artery banding (PAB). Complex TGA anatomy, including transposition of the great arteries and ventricular septal defect (TGA-VSD) or double outlet right ventricle and ventricular septal defect (DORV-VSD), is also an independent risk factor for neo-aortic dilatation and aortic valve regurgitation. Aortic valve and root replacement is sometime necessary for the patients with these pathologies long-term after ASO. Here, we present a patient who had persistent aortic sinus dilatation and aortic valve insufficiency since ASO and necessitating aortic root and valve replacement 15 years after ASO preceded by PAB. The patient underwent Bentall operation and his clinical course was favorable. Histological findings after root replacement revealed no remarkable structural difference between neo-aortic wall (originally pulmonary artery) and original aortic wall.
摘要：
尽管动脉转换手术（ASO）用于大动脉转位（TGA）的短期和中期结果有了很大改善，一些并发症包括肺动脉狭窄,主动脉瓣关闭不全,和主动脉根部扩张也有报道。在ASO之后,原来的肺根和瓣膜，在全身位置分别作为新主动脉根部和瓣膜发挥作用，暴露于全身血压，导致某些患者的主动脉根部扩张和瓣膜功能不全。这些并发症的危险因素之一是先前的肺动脉束带（PAB）病史。复杂的TGA解剖学，包括大动脉转位和室间隔缺损（TGA-VSD）或右心室双出口和室间隔缺损（DORV-VSD），也是新主动脉扩张和主动脉瓣反流的独立危险因素。对于ASO术后长期患有这些疾病的患者，有时需要主动脉瓣和根部置换。这里,我们介绍了一名患者,该患者自ASO后出现持续的主动脉窦扩张和主动脉瓣关闭不全,在ASO后15年需要进行主动脉根和瓣置换术,然后进行PAB.患者接受了Bentall手术，其临床过程良好。根置换后的组织学发现显示，新主动脉壁（原始肺动脉）和原始主动脉壁之间没有显着结构差异。
