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Risk Factors for Neo-Aortic Root Enlargement and Aortic Regurgitation Following Arterial Switch Operation

机译：动脉切换手术后新主动脉根扩大和主动脉反流的危险因素

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摘要

The objectives of this study were to evaluate changes in dimension of the neo-aortic annulus, aortic root, and aortic anastomosis following arterial switch operation (ASO) and to identify risk factors for developing abnormal neo-aortic root enlargement and aortic regurgitation (AR). Prior studies report development of neo-aortic root dilatation and AR in a small subset of patients after ASO. Predisposing factors for neo-aortic root dilatation and development of moderate/severe AR are poorly understood. We performed a retrospective review of all patients with d-transposition of the great arteries (d-TGA) or double-outlet right ventricle with subpulmonary ventricular septal defect (VSD) who underwent ASO from May 1986 to January 2001. Serial echocardiograms were reviewed to measure neo-aortic annulus, root, and anastomosis diameter (z scores) and to determine progression of AR. Potential risk factors were assessed for developing neo-aortic root enlargement and AR. There were 119 patients (44 female and 75 male): 73 patients had simple d-TGA, 36 had d-TGA with ventricular septal defect, and 10 had a Taussig–Bing heart. The median duration of follow-up was 65 months (range, 12–180). The median neo-aortic root (z = 0.55 ± 2.2; p < 0.01) and aortic annulus dimensions (z = 1.57 ± 1.75; p < 0.01) were significantly increased over the study period. Aortic anastomosis diameter correlated with growth of the ascending aorta (z = 0.55 ± 1.24). Development of severe neo-aortic root enlargement was associated with prior pulmonary artery (PA) banding (p < 0.01), the presence of a VSD (p = 0.03), and Taussig–Bing anatomy (p < 0.01) but was independent of coronary arterial anatomy, coronary arterial transfer technique, or associated lesions (p > 0.05). At latest follow-up, there was no or trivial AR in 88 patients, mild AR in 29 patients, and moderate to severe AR in 3 patients. Risk factors for developing mild or worse AR included severe or rapid neo-aortic root dilatation (p < 0.01). Only 3 patients required surgical intervention for AR. Despite the significant prevalence of neo-aortic root enlargement at intermediate follow-up after ASO, there is a low incidence of significant AR. Prior PA banding, the presence of VSD, and Taussig–Bing anatomy are risk factors for severe root enlargement. Surgical intervention for AR was rare (2%), however, serial surveillance of such patients is vital to monitor for neo-aortic root enlargement and potential aortic valve dysfunction.
机译：这项研究的目的是评估动脉切换手术（ASO）后新主动脉瓣环，主动脉根和主动脉吻合的尺寸变化，并确定发展异常的新主动脉根扩大和主动脉瓣反流（AR）的风险因素。先前的研究报道了ASO后一小部分患者出现新主动脉根部扩张和AR。对新主动脉根扩张和中度/重度AR发生的易感因素了解甚少。我们对1986年5月至2001年1月接受ASO的所有大动脉D型转位（d-TGA）或双出口右心室并发肺下室间隔缺损（VSD）的患者进行了回顾性研究。测量新主动脉瓣环，根和吻合直径（z评分）并确定AR的进展。评估潜在的危险因素发展新主动脉根扩大和AR。有119例患者（44例女性和75例男性）：73例患有简单d-TGA，36例患有室间隔缺损的d-TGA，10例具有Taussig-Bing心脏。中位随访时间为65个月（范围12–180）。在研究期间，中位新主动脉根（z = 0.55±2.2; p <0.01）和主动脉瓣环尺寸（z = 1.57±1.75; p <0.01）显着增加。主动脉吻合直径与升主动脉的生长相关（z = 0.55±1.24）。严重的新主动脉根部扩张的发展与先前的肺动脉束带（PA <0.01），VSD的存在（p = 0.03）和Taussig-Bing解剖结构（p <0.01）有关，但与冠状动脉无关动脉解剖，冠状动脉转移技术或相关病变（p> 0.05）。在最新的随访中，88例患者中没有或仅有微不足道的AR，29例患者为轻度AR，3例患者为中度至重度AR。发生轻度或重度AR的危险因素包括严重或快速的新主动脉根部扩张（p <0.01）。仅3例需要AR的手术干预。尽管在ASO后的中期随访中，新主动脉根部增大的发生率很高，但发生AR的几率很低。先前的PA绑扎，VSD的存在以及Taussig-Bing解剖结构是严重牙根肿大的危险因素。 AR的外科手术很少见（2％），但是，对此类患者进行连续监测对于监测新主动脉根部扩大和潜在的主动脉瓣功能异常至关重要。

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  • 来源
    《Pediatric Cardiology》 |2004年第4期|329-335|共7页
  • 作者

    C. J. McMahon; W. J. Ravekes; E. O’Brian Smith; S. W. Denfield; R. H. Pignatelli; C. A. Altman; N. A. Ayres;

  • 作者单位

    Lillie Frank Abercrombie Division of Pediatric Cardiology Texas Children’s Hospital and Baylor College of Medicine 6621 Fannin Houston 77030 TX;

    Department of Pediatric Cardiology Johns Hopkins University 600 N Wolfe Street Baltimore MD;

    Department of Biostatistics Children’s Nutrition and Research Center Houston TX;

    Lillie Frank Abercrombie Division of Pediatric Cardiology Texas Children’s Hospital and Baylor College of Medicine 6621 Fannin Houston 77030 TX;

    Lillie Frank Abercrombie Division of Pediatric Cardiology Texas Children’s Hospital and Baylor College of Medicine 6621 Fannin Houston 77030 TX;

    Lillie Frank Abercrombie Division of Pediatric Cardiology Texas Children’s Hospital and Baylor College of Medicine 6621 Fannin Houston 77030 TX;

    Lillie Frank Abercrombie Division of Pediatric Cardiology Texas Children’s Hospital and Baylor College of Medicine 6621 Fannin Houston 77030 TX;

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  • 正文语种 eng
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  • 关键词

    Arterial switch operation; Transposition of the great arteries; Aortic regurgitation; Neo-aorta;

    机译：动脉转换术;大动脉移位;主动脉瓣关闭不全;新主动脉;

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