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Coronary Artery Problems Late After Arterial Switch Operation for Transposition of the Great Arteries

机译：大动脉移位手术后的冠状动脉问题

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Background: The incidence of late coronary artery abnormalities after arterial switch operation (ASO) for d-loop transposition of the great arteries may be underestimated. Methods?and?Results: We retrospectively reviewed coronary artery morphology in 40 of 97 patients who survived the first year after ASO. Seven asymptomatic patients developed significant late coronary artery abnormalities. One patient died suddenly at home with severe left coronary artery (LCA) ostial stenosis at age 3.8 years. The second patient collapsed during exercise at age 9.6 years due to ventricular fibrillation and severe LCA ostial stenosis despite prior negative exercise stress test (EST) and myocardial perfusion imaging (MPI). The third patient was found to have moderate ostial stenosis of the LCA with negative EST and MPI. The fourth patient with exercise-induced ST-T depression and myocardial perfusion defect was shown to have complete LCA occlusion with collateral vessel formation. Three other patients had complete proximal obliteration of either of the coronary arteries with collateral supply. An additional 4 asymptomatic patients had trivial-mild narrowing of the LCA on routine selective coronary angiogram. Conclusions: Incidence of late coronary stenosis or occlusion was not infrequent after ASO (11.3%) and presented usually without preceding symptoms and often after negative non-invasive screening. We advocate routine coronary imaging in all patients after ASO before they participate in competitive sports. ( Circ J 2015; 79: 2372–2379)
机译：背景：大动脉d环转位的动脉切换手术（ASO）后晚期冠状动脉异常的发生率可能被低估了。方法和结果：我们回顾性分析了ASO后第一年存活的97例患者中40例的冠状动脉形态。 7名无症状患者出现了严重的晚期冠状动脉异常。一名患者在家中突然死亡，年龄为3.8岁，患有严重的左冠状动脉狭窄。尽管有先前的负运动压力测试（EST）和心肌灌注显像（MPI），但第二名患者在9.6岁的运动期间因室颤和严重的LCA狭窄而晕倒。第三位患者被发现为LCA中度狭窄，EST和MPI阴性。第四例因运动引起的ST-T抑郁和心肌灌注缺陷的患者表现出完全LCA闭塞并伴有侧支血管形成。其他三名患者的侧支完全闭塞了其中任一冠状动脉。在常规的选择性冠状动脉造影检查中，另有4名无症状患者的LCA轻度轻度狭窄。结论：ASO后发生冠状动脉狭窄或闭塞的情况并不罕见（11.3％），并且通常没有先兆症状且通常在阴性的非侵入性筛查后出现。我们提倡对所有参加ASO后的患者进行常规冠状动脉成像，然后再参加竞技运动。 （Circ J 2015; 79：2372–2379）

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