Abstract

The arterial switch operation for d-transposition of the great arteries achieves anatomic repair but creates the potential for right ventricular outflow tract obstruction as a result of the LeCompte maneuver. The resultant right ventricular hypertension is generally well tolerated but a select group are referred for cardiac catheterization. The outcomes of these catheterizations have not been well described. The objective of this study was to describe the degree and nature of right ventricular outflow tract obstruction found during cardiac catheterization among patients following the arterial switch operation as well as determine the rate of intervention and assess the acute impact of any catheter intervention undertaken. We conducted a retrospective study of patients after arterial switch operation with the LeCompte maneuver and subsequent right heart catheterization. Descriptive statistics were reported, and paired sample t tests were used for analysis. 544 children had an arterial switch operation, of which 110 children (20%) had a cardiac catheterization procedure after surgery and 11% had a right heart catheterization. Of the right heart catheterizations, 90% had an intervention (balloon and/or stent). In the interventional group, the right ventricle to systemic pressure ratio decreased modestly, from 2/3 to half systemic, after balloon dilation and/or stent placement (p < 0.01). No serious complications were observed.

中文翻译：

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动脉调转手术后右心室流出道和肺动脉分支的心导管插入干预

摘要

用于大动脉 d 转位的动脉调转手术实现了解剖修复，但由于 LeCompte 操作而可能造成右心室流出道阻塞。由此产生的右心室高压通常可以很好地耐受，但有一部分被转介进行心导管插入术。这些导管插入术的结果尚未得到很好的描述。本研究的目的是描述动脉调转手术后患者心导管插入术中发现的右心室流出道梗阻的程度和性质，并确定干预率并评估所进行的任何导管干预的急性影响。我们对采用 LeCompte 操作进行动脉调转手术并随后进行右心导管插入术的患者进行了回顾性研究。报告描述性统计数据，并使用配对样本 t 检验进行分析。 544 名儿童接受了动脉调转手术，其中 110 名儿童（20%）在术后接受了心导管插入术，11% 接受了右心导管插入术。在右心导管插入术中，90% 进行了干预（球囊和/或支架）。在介入组中，球囊扩张和/或支架置入后，右心室与全身压力之比略有下降，从全身压力的 2/3 降至一半 ( p  < 0.01)。没有观察到严重的并发症。