Midterm follow-up of arterial switch operation for transposition of the great arteries with intact ventricular septum and left-ventricular outflow tract obstruction☆

The surgical management of d-transposition of great arteries (d-TGAs) with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO) is ever evolving and still remains a challenge because of wide anatomic variability, age of presentation, surgical options available, and their variable long-term results in different series. We describe a patient with d-TGA, VSD, and LVOTO who presented to us at 13 years of age and underwent an arterial switch operation along with neoaortic valve replacement with a mechanical prosthesis. The postoperative course was uneventful, and at hospital discharge, the echocardiogram was satisfactory. We present the pros and cons of this hitherto undescribed treatment option.

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Complete transposition of the great arteries with intact ventricular septum and left ventricular outflow tract obstruction

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/s0022-5223(19)38059-6 ◽

1979 ◽

Vol 78 (5) ◽

pp. 730-738 ◽

Cited By ~ 21

Author(s):

Giancarlo Crupi ◽

Robert H. Anderson ◽

Siew Yen Ho ◽

Christopher Lincoln ◽

Mortimer J. Buckley

Keyword(s):

Left Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Outflow Tract ◽

Ventricular Septum ◽

Intact Ventricular Septum ◽

Ventricular Outflow Tract Obstruction ◽

Complete Transposition ◽

Left Ventricular Outflow

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Transposition of the great vessels and intact ventricular septum: is there an age limit for the arterial switch? Personal experience and review of the literature

Cardiology in the Young ◽

10.1017/s1047951120001456 ◽

2020 ◽

Vol 30 (7) ◽

pp. 1012-1017

Author(s):

Zied Daoud ◽

Halkawt Ali Nuri ◽

Ambra Miette ◽

Giuseppe Pomè

Keyword(s):

Myocardial Dysfunction ◽

Arterial Switch Operation ◽

Left Ventricular ◽

Ventricular Septum ◽

Circulatory Support ◽

Intact Ventricular Septum ◽

Arterial Switch ◽

Switch Time ◽

Switch Operation ◽

Great Vessels

AbstractObjective:Prognosis of the transposition of the great arteries has completely changed since the introduction of the arterial switch. Time limit to perform this intervention is still controversial. The aim of this study is to demonstrate the early and late outcome of primary arterial switch operation beyond the age of months.Methods:We included all patients with the diagnosis of transposition of the great arteries with intact ventricular septum beyond the age of 8 weeks who underwent primary arterial switch operation. The procedures were performed by the same surgeon, in two different institutes. Patients who had transposition of the great arteries and associated anomalies (except atrial septal defect and persistent arterial duct) were excluded. Ventricular shape, geometry, and mass were not considered during the decision on procedure type.Results:In the study, 11 patients with the diagnosis of simple d-transposition of the great arteries beyond 8 weeks were undergone primary arterial switch operation with a mean age of 90.63 days (60–137 days), and 7 patients had a Rashkind procedure. All patients had squashed left ventricle shape with preserved function. The sternum was left open in 10 patients. Extracorporeal membrane oxygenation support was necessary in 45.45% of cases. The mean mechanical ventilation time was 7.27 days (1–16 days). No mortality was recorded until now. Post-operatory left ventricular function was preserved in 90.9% of the patients. Only one patient had mild myocardial dysfunction at the time of discharge.Conclusions:Primary arterial switch procedure can still be the best surgical option in patients with the diagnosis of transposition of the great arteries with intact ventricular septum beyond 8 weeks of age, providing that mechanical circulatory support and an expert cardiac intensive care unit service are available.

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Is the function of all cardiac valves after the arterial switch operation influenced by an associated ventricular septal defect?

Cardiology in the Young ◽

10.1017/s1047951111000084 ◽

2011 ◽

Vol 21 (4) ◽

pp. 383-391

Author(s):

J. Gabriel ◽

H.-H. Scheld ◽

T.D.T. Tjan ◽

N. Osada ◽

Thomas Krasemann

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Arterial Switch Operation ◽

Pulmonary Stenosis ◽

Ventricular Septum ◽

Intact Ventricular Septum ◽

Cardiac Valves ◽

Arterial Switch ◽

Switch Operation

AbstractA ventricular septal defect in transposition of the great arteries is frequently closely related to the cardiac valves. The valvar function after arterial switch operation of patients with transposition of the great arteries and ventricular septal defect or intact ventricular septum was compared. We analysed the function of all cardiac valves in patients who underwent the arterial switch operations pre- and post-operatively, 1 year after the procedure and on follow-up. The study included 92 patients – 64 with transposition of the great arteries/intact ventricular septum and 28 with transposition of the great arteries/ventricular septal defect. The median age at surgery was 5.5 days in transposition of the great arteries/intact ventricular septum (0–73 days) and 7.0 days in transposition of the great arteries/ventricular septal defect (4–41 days). Follow-up was 51.7 months in transposition of the great arteries/intact ventricular septum (3.3–177.3 months) and 55 months in transposition of the great arteries/ventricular septal defect (14.6–164.7 months). Neo-aortic, neo-pulmonary, and mitral valvar function did not differ. Tricuspid regurgitation was more frequent 1 year post-operatively in transposition of the great arteries/ventricular septal defect (n = 4) than in transposition of the great arteries/intact ventricular septum. The prevalence of neo-aortic regurgitation and pulmonary stenosis increased over time, especially in patients with transposition of the great arteries/intact ventricular septum. The presence of a ventricular septal defect in patients undergoing arterial switch operation for transposition of the great arteries only has a minor bearing for the development of valvar dysfunction on the longer follow-up.

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