大動脈完全轉位術後左右肺動脈成長之研究

In the present era of arterial switch operation, supravalvular pulmonary stenosis remains
a problem. First branch pulmonary arterial hypoplasia in transposition of the great arteries was
documented prior to and after palliative or corrective surgery. We sought to determine the
morphological features of the pulmonary trunk (PT) and its branches susceptible to first
branch pulmonary arterial (PA) hypoplasia in transposition of the great arteries (TGA). All
available angiograms between 1981 and 2003 were reviewed and polaroid photos were taken
at end-systolic phase. The diameters of the right PA (RPA), the left PA (LPA) and the PT
before their first branch, and the angle between the RPA and right border of the PT were
measured in frontal view. In addition, the angle between both PA and posterior border of the
PT, and the diameter of the ascending aorta were measured in lateral view. The diameter ratio
of PA to PT was compared before and after two palliative operations (shunt with or without
concomitant PT banding) and two corrective operations (Senning or Jatene). We found that
shunt alone (n=3) had regression of PA size. Whereas those who had concomitant PT banding
(n=2) to abolish hemodynamic starvation had PA growth. Those who underwent Senning
operation (n=4) had PA growth, but the growth was not as good and rapid as Jatene group
with Lecompte maneuver (n=14).Thus the natural and second natural history of PA hypoplasia
in TGA is about the same, namely, hemodynamic starvation and posterior inclination of PT
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would lead to PA hypoplasia in TGA both before and after surgical intervention. We conclude
that the surgical options that eliminate the-above-mentioned pathogenesis of PA hypoplasia
like shunt with PT banding or Jatene with Lecompte (or had better with Pacifico or spiral
reconstruction) could facilitate PA growth in TGA.