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Value of preoperative echocardiography for the diagnosis of coronary artery patterns in neonates with transposition of the great arteries.

术前超声心动图对新生儿大动脉转位冠状动脉模式的诊断价值 [j].

  • 影响因子:2.06
  • DOI:10.1016/j.acvd.2020.06.005
  • 作者列表:"Bertail-Galoin C","Leconte C","Bakloul M","Perouse-de-Montclos T","Moulin-Zinsch A","Martin-Bonnet C","Debost B","Di Filippo S
  • 发表时间:2021-02-01
Abstract

BACKGROUND:Abnormal coronary pattern may complicate coronary transfer during arterial switch operation. OBJECTIVE:To evaluate the accuracy of echocardiography in assessing the anatomy of coronary arteries in neonates with transposition of the great arteries, and determine impact on outcomes. METHODS:We conducted a retrospective analysis of data in neonates with transposition of the great arteries. Preoperative echocardiographic coronary artery pattern and surgical intraoperative reports were compared. Mismatch between transthoracic echocardiography and surgical intraoperative reports and the impact on perioperative outcome were assessed. Coronary patterns were classified into four groups: type 1 (normal); type 2 (risk of coronary with intramural course); type 3 (coronary loop); and type 2+3. RESULTS:Overall, 108 neonates who underwent an arterial switch operation were included: 68 were classified as type 1; seven as type 2; 32 as type 3; and one as type 2+3. Overall, 10 adverse events occurred. Five patients died, three from coronary causes. Survival was 96% at 1 month. Transthoracic echocardiography and surgical intraoperative reports differed in 17.6% of cases. Mortality was 15.8% in case of inappropriate diagnosis and 2.2% for appropriate diagnosis (P=0.01). Mortality in type 2 was 66.7% in case of discordance versus 0% when concordant. Multivariable analysis found that inappropriate preoperative transthoracic echocardiography diagnosis of coronary pattern was the only significant risk factor for mortality (P=0.04). CONCLUSIONS:Echocardiography can assess coronary artery anatomy in neonates with transposition of the great arteries. Intramural coronary course is often misdiagnosed. Preoperative misdiagnosis of coronary artery anomaly may impact perioperative mortality. However, this assessment will have to be confirmed by further larger studies.

摘要

背景: 在动脉转换手术中,冠状动脉模式异常可能使冠状动脉转移复杂化。 目的: 评价超声心动图评价新生儿大动脉转位冠状动脉解剖的准确性及其对预后的影响。 方法: 对新生儿大动脉转位病例进行回顾性分析。比较术前超声心动图冠状动脉模式和手术术中报告。评估了经胸超声心动图与手术术中报告之间的不匹配以及对围手术期结果的影响。冠状动脉模式分为四组: 1型 (正常); 2型 (有壁内病程的冠状动脉风险); 3型 (冠状动脉环); 和2 + 3型。 结果: 共纳入108例接受动脉转位手术的新生儿: 68例为1型; 7例为2型; 32例为3型; 1例为2 + 3型。总体上,发生了10例不良事件。5例患者死亡,3例死于冠状动脉原因。1个月时存活率为96%。17.6% 的病例经胸超声心动图和手术中报告不同。不恰当诊断的死亡率为15.8%,恰当诊断的死亡率为2.2% (P = 0.01)。在不一致的情况下,2型的死亡率为66.7%,在一致的情况下为0%。多因素分析发现,术前经胸超声心动图诊断冠脉模式不当是死亡的唯一显著危险因素 (P = 0.04)。 结论: 超声心动图可评价大动脉转位新生儿冠状动脉解剖结构。冠状动脉壁内病变常被误诊。术前误诊冠状动脉异常可能影响围手术期死亡率。然而,这一评估必须得到更大规模研究的证实。

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