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Abstract：
BACKGROUND: Arterial switch operation (ASO) is the standard surgical choice for D-transposition of great arteries (D-TGA). However, the implications of ASO on pulmonaries, coronaries, and aorta have not been adequately investigated. The current study evaluates arterial morphologic changes post-ASO at intermediate-term surveillance.
METHODS: From May 2021 to May 2022, patients with D-TGA who underwent ASO for more than six months were recruited. Preoperative and operative data were collected. Patients were assessed using echocardiography (ECHO) and multislice CT angiography (MSCT) to evaluate pulmonary, coronary, and aortic arterial anatomy.
RESULTS: Twenty patients were included with median age of 11 (10-23.25) days at ASO and 14 (7.25-32.75) months on last follow-up. Neo-aortic regurgitation was detected in 12(60%) and neo-pulmonary regurgitation in 3 (15%). Using ECHO, complete evaluation of pulmonary arteries (PAs) was not achieved in 35% and incomplete coronaries assessment in 40% of cases. No stenosis was detected in coronaries using MSCT, although coronary anomalies were found in 9/20 (45%). Dilated Aortic annulus was detected in 16/20 (80%), dilated aortic root in 18/20 (90%), and dilated sinotubular junction in 70%. Right PA stenosis was diagnosed in 10/20 (50%) and left PA(LPA) stenosis in 7/20 (35%). Although Z-score of PAs did not correlate with aortic data, LPA bending angle was positively correlated to neo-aortic root diameter and Z-score (rho = 0.65,p = 0.016; rho = 0.69,p = 0.01), respectively.
CONCLUSIONS: Echocardiography alone is not a conclusive surveillance tool for detecting late post-ASO anatomic changes in D-TGA patients. Cardiac MSCT should be considered for comprehensive evaluation on the intermediate-term follow-up post-ASO to accurately track morphologic abnormalities in the aorta, pulmonary, and coronary arteries.
METHODS: From May 2021 to May 2022, patients with D-TGA who underwent ASO for more than six months were recruited. Preoperative and operative data were collected. Patients were assessed using echocardiography (ECHO) and multislice CT angiography (MSCT) to evaluate pulmonary, coronary, and aortic arterial anatomy.
RESULTS: Twenty patients were included with median age of 11 (10-23.25) days at ASO and 14 (7.25-32.75) months on last follow-up. Neo-aortic regurgitation was detected in 12(60%) and neo-pulmonary regurgitation in 3 (15%). Using ECHO, complete evaluation of pulmonary arteries (PAs) was not achieved in 35% and incomplete coronaries assessment in 40% of cases. No stenosis was detected in coronaries using MSCT, although coronary anomalies were found in 9/20 (45%). Dilated Aortic annulus was detected in 16/20 (80%), dilated aortic root in 18/20 (90%), and dilated sinotubular junction in 70%. Right PA stenosis was diagnosed in 10/20 (50%) and left PA(LPA) stenosis in 7/20 (35%). Although Z-score of PAs did not correlate with aortic data, LPA bending angle was positively correlated to neo-aortic root diameter and Z-score (rho = 0.65,p = 0.016; rho = 0.69,p = 0.01), respectively.
CONCLUSIONS: Echocardiography alone is not a conclusive surveillance tool for detecting late post-ASO anatomic changes in D-TGA patients. Cardiac MSCT should be considered for comprehensive evaluation on the intermediate-term follow-up post-ASO to accurately track morphologic abnormalities in the aorta, pulmonary, and coronary arteries.
摘要：
背景：动脉转换手术（ASO）是大动脉D转位（D-TGA）的标准手术选择。然而,ASO对脉搏的影响，验尸官,和主动脉没有得到充分的调查。本研究评估中期监测ASO后动脉形态变化。
方法：从2021年5月至2022年5月，招募接受ASO超过6个月的D-TGA患者。收集术前和手术数据。使用超声心动图（ECHO）和多层螺旋CT血管造影（MSCT）评估患者的肺，冠状动脉,和主动脉动脉解剖.
结果：纳入20例患者，年龄中位数为11（10-23.25）天，末次随访为14（7.25-32.75）个月。12例（60％）检测到新主动脉瓣反流，3例（15％）检测到新肺动脉瓣反流。使用ECHO，35%的病例未完成肺动脉(PAs)评估,40%的病例未完成冠状动脉评估.MSCT在冠状动脉中没有发现狭窄，尽管在9/20（45％）中发现了冠状动脉异常。16/20（80%）发现主动脉环扩张，18/20（90%）主动脉根部扩张，70%的窦管交界处扩张。右侧PA狭窄诊断为10/20（50％），左侧PA（LPA）狭窄诊断为7/20（35％）。尽管PA的Z评分与主动脉数据不相关，LPA弯曲角度与新主动脉根径和Z评分呈正相关(rho=0.65,p=0.016;rho=0.69,p=0.01),分别。
结论：超声心动图并不是检测D-TGA患者ASO术后晚期解剖改变的决定性监测工具。应考虑对ASO后中期随访进行心脏MSCT的综合评估，以准确跟踪主动脉的形态异常，肺,还有冠状动脉.
方法：从2021年5月至2022年5月，招募接受ASO超过6个月的D-TGA患者。收集术前和手术数据。使用超声心动图（ECHO）和多层螺旋CT血管造影（MSCT）评估患者的肺，冠状动脉,和主动脉动脉解剖.
结果：纳入20例患者，年龄中位数为11（10-23.25）天，末次随访为14（7.25-32.75）个月。12例（60％）检测到新主动脉瓣反流，3例（15％）检测到新肺动脉瓣反流。使用ECHO，35%的病例未完成肺动脉(PAs)评估,40%的病例未完成冠状动脉评估.MSCT在冠状动脉中没有发现狭窄，尽管在9/20（45％）中发现了冠状动脉异常。16/20（80%）发现主动脉环扩张，18/20（90%）主动脉根部扩张，70%的窦管交界处扩张。右侧PA狭窄诊断为10/20（50％），左侧PA（LPA）狭窄诊断为7/20（35％）。尽管PA的Z评分与主动脉数据不相关，LPA弯曲角度与新主动脉根径和Z评分呈正相关(rho=0.65,p=0.016;rho=0.69,p=0.01),分别。
结论：超声心动图并不是检测D-TGA患者ASO术后晚期解剖改变的决定性监测工具。应考虑对ASO后中期随访进行心脏MSCT的综合评估，以准确跟踪主动脉的形态异常，肺,还有冠状动脉.
