Lung Transplantation in a Young Patient With Pulmonary Artery Hypertension After Arterial Switch Operation: A Case Report

2021 ◽  
Author(s):  
David Poveda ◽  
Eloisa Ruiz ◽  
Alba Maria Fernandez ◽  
Francisco Javier Gonzalez ◽  
Paula Moreno ◽  
...  
Keyword(s):  
Case Report ◽  
Pulmonary Artery ◽  
Lung Transplantation ◽  
Young Patient ◽  
Arterial Switch Operation ◽  
Pulmonary Artery Hypertension ◽  
Arterial Switch ◽  
Switch Operation

Alternative pulmonary artery reconstruction technique in the arterial switch operation

2021 ◽  
Author(s):  
Hisayuki Hongu ◽  
Masaaki Yamagishi ◽  
Yoshinobu Maeda ◽  
Keiichi Itatani ◽  
Masatoshi Shimada ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Arterial Switch Operation ◽  
Late Complication ◽  
Late Complications ◽  
Reconstruction Technique ◽  
Reconstruction Method ◽  
Arterial Switch ◽  
Switch Operation ◽  
Longitudinal Extension

Abstract OBJECTIVES Late complications of arterial switch operations (ASO) for transposition of the great arteries, such as neo-pulmonary artery (PA) stenosis and/or neoaortic regurgitation, have been reported. We developed an alternative reconstruction method called the longitudinal extension (LE) method to prevent PA bifurcation stenosis (PABS). METHODS We identified 48 patients diagnosed with transposition of the great arteries and performed ASO using the Lecompte manoeuvre for neo-PA reconstruction. In 9 consecutive patients (from 2014), the LE method was performed (LE). Before 2014, conventional techniques were performed in 39 patients (C). The median body weight and age in the LE and C groups were 3.0 and 3.1 kg and 12 and 26 days, respectively. In the LE group, 1 patient underwent bilateral PA banding before ASO. In C, PA banding and arch repair were performed in 1 patient each. Patients who received concomitant procedures were included. RESULTS The median follow-up in LE and C groups was 1.9 and 10.1 years, respectively. Early mortality/late death was not found in group LE and in 1 patient in group C. Only 1 case required ascending aorta sliding plasty in LE, and 8 patients needed PA augmentation for PABS in C. The median velocity of right/left PA was measured as 1.6/1.9 m/s in LE and 2.1/2.3 m/s in C, so it showed a lower value in LE. CONCLUSIONS Excellent mid-term results were obtained with the LE method. It was considered a useful procedure in preventing PABS, which is a primary late complication of ASO. Further follow-up and investigations are needed.

Abstract 16754: Novel Characterization of Pulmonary Artery Bending, Rather Than Stenosis, Detects Increased Right Ventricular Afterload and is Associated With Increased Right Ventricular Mass in the Post-Arterial Switch Operation Heart

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Marc A Delaney ◽  
Paige Mass ◽  
Francesco Capuano ◽  
Yue-hin Loke ◽  
Laura Olivieri
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Arterial Switch Operation ◽  
Radius Of Curvature ◽  
Transposition Of Great Arteries ◽  
Arterial Switch ◽  
Switch Operation

Introduction: Surgical treatment of transposition of great arteries involves the Arterial Switch Operation (ASO) and the LeCompte maneuver, where the pulmonary artery (PA) and its bifurcation are translocated anterior to the neoaortic root, creating relative PA stenosis and exaggerated PA bending. Assessment of branch PA dimensions can identify stenosis, however complex 3-dimensional bending without clear stenosis may contribute to elevated right ventricular (RV) afterload. Initial data suggest elevated RV afterload and RV mass are prevalent in these patients but the etiology and associated risk factors remain unclear. Hypothesis: In post-ASO patients, more extreme PA bending, as described by radius of curvature, will be associated with elevated RV afterload and RV mass independently of relative PA stenosis. Methods: Retrospective single-center analysis of 22 post-ASO patients was performed, representing native anatomy of D-TGA with (15, 68%) and without (7, 32%) intact ventricular septum, excluding those with PA stent, pulmonary hypertension, or other anatomical confounders. RV systolic pressure (RVSP) was recorded from echocardiography (11, 50%) or catheterization (11, 50%) and correlated to cardiac magnetic resonance (CMR) imaging measurements including: radius of curvature (Rcw) weighted to differential pulmonary blood flow and RV mass indexed to body surface area. Results: In ASO patients, receiver operating characteristic curve demonstrated Rcw, but not PA stenosis, moderately detected presence of elevated RVSP (>40 mmHg) (respectively: AUC 0.84, p = 0.03 and AUC 0.49, p =0.60). Patients with elevated RV Mass had more extreme Rcw (when normalized to body surface area), but no difference in PA stenosis via Nakata index (respectively: p = 0.10, p = 0.02). Conclusions: Abnormal PA bending as described by Rcw is associated with increased RV afterload and RV Mass. Rcw may serve as a promising future clinical proxy to RV afterload.

scholarly journals The behavior of residual pulmonary artery gradient after arterial switch operation: A longitudinal data analysis

2020 ◽  
Vol 35 (11) ◽  
pp. 2927-2933
Author(s):  
Hani N. Alkattan ◽  
Obayda M. Diraneyya ◽  
Hatem A. Elmontaser ◽  
Joohum Jaweed ◽  
Abdulsalam M. Alsaiad ◽  
...  
Keyword(s):  
Data Analysis ◽  
Pulmonary Artery ◽  
Longitudinal Data ◽  
Arterial Switch Operation ◽  
Longitudinal Data Analysis ◽  
Arterial Switch ◽  
Switch Operation

Pulmonary artery banding and venous bidirectional cava-pulmonary shunt for two-stage arterial switch procedure in late referral of patients with transposition of the great arteries and intact ventricular septum: midterm results

2019 ◽  
Vol 29 (5) ◽  
pp. 649-654
Author(s):  
Ayhan Cevik ◽  
Ali Rıza Karaci ◽  
Bulent Polat ◽  
Murat Erturk ◽  
Yalım Yalcin ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Pulmonary Artery ◽  
Arterial Switch Operation ◽  
Pulmonary Artery Banding ◽  
Pulmonary Shunt ◽  
Left Ventricle Mass ◽  
Arterial Switch ◽  
Group I ◽  
Switch Operation ◽  
Left Ventricle Dysfunction

AbstractObjective:Two-stage arterial switch operation and left ventricle retraining are necessary for the patients with left ventricle dysfunction and transposition of great vessels with intact ventricular septum (TGA-IVS) who are referred late.Material and methods:Forty-seven patients with the diagnosis of TGA-IVS and left ventricle dysfunction who underwent arterial switch operation in our centre between July 2013 and August 2017 were analysed retrospectively. The inclusion criteria for left ventricle retraining were patients older than 2 months of age at presentation, having an echocardiographic left ventricle mass index of less than 35 g/m², and having an echocardiographic “banana-shaped” left ventricle geometric appearance. The patients were divided into two groups: pulmonary artery banding and Blalock Taussig shunt were performed as the initial surgical procedure for later arterial switch operation in Group I (n = 19) and pulmonary artery banding and bidirectional cava-pulmonary shunt in Group 2 (n = 28).Results:The average age was found to be 122.3 ± 45.6 days in Group I and 145.9 ± 37.2 days in Group II. There was no statistically significant difference (p = 0.232 versus p = 0.373) between the average left ventricle mass index of the two groups neither before the first stage nor the second stage (26.6 ± 4.8 g/m² versus 25.0 ± 4.9 g/m² and 70.5 ± 12 g/m² versus 673.8 ± 12.0 g/m², respectively). The average time interval for the left ventricle to retrain was 97.7 ± 42.9 days for Group I and 117.3 ± 40.3 days for Group II, significantly lower in Group I (p = 0.027). The time spent in ICU, length of the period during which inotropic support was required, and the duration of hospital stay were significantly higher in Group I (p<0.001, p < 0.001, and p < 0.00, respectively).Conclusion:Pulmonary artery banding and bidirectional cava-pulmonary shunt can be performed as a safe and effective alternative to pulmonary artery banding and arterial Blalock Taussig shunt for patients with TGA-IVS in whom arterial switch operation is needed beyond the neonatal period. This approach involves a shorter hospital stay and fewer post-operative complications.

Biventricular Repair of Double Outlet Right Ventricle: Preoperative Echocardiography and Surgical Outcomes

2017 ◽  
Vol 8 (3) ◽  
pp. 354-360 ◽  
Author(s):  
Hong Meng ◽  
Kun-Jing Pang ◽  
Shou-Jun Li ◽  
David Hsi ◽  
Jun Yan ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Arterial Switch Operation ◽  
Double Outlet Right Ventricle ◽  
Double Root ◽  
Biventricular Repair ◽  
Arterial Switch ◽  
Switch Operation ◽  
Hospital Deaths ◽  
Selection Of

Objective: To discuss the key anatomic features of double outlet right ventricle (DORV) assessed by preoperative echocardiography among patients treated with different types of biventricular repair. Methods: Surgical and echocardiographic databases were queried to identify patients who had undergone biventricular repair for DORV and had adequate preoperative echocardiographic imaging. All patients underwent pre- and postoperative echocardiography and clinical evaluation following discharge. Results: Two hundred sixty-two patients with DORV met the inclusion criteria of the study. The patients were divided into two groups—intraventricular tunnel repair (IVR) to the aorta (194 [74%] patients) or to the pulmonary artery with either concomitant arterial switch operation or double-root translocation (68 [26%] patients). Among 68 patients undergoing IVR to the pulmonary artery, 50 patients with transposition of the great arteries (TGA) type of DORV and 7 patients with remote ventricular septal defect (VSD) type underwent IVR plus arterial switch operation and 6 patients with TGA type and 5 patients with remote VSD type underwent IVR plus double-root translocation. There were three hospital deaths and one late death (overall operative mortality: 1.5%). Conclusion: Preoperative echocardiography provided crucial data to estimate the feasibility of intraventricular tunnel creation to either the aorta or the pulmonary artery and to guide the selection of either arterial switch or double-root translocation. Biventricular repair could be achieved with favorable outcomes in most patients with DORV.

Challenges for bilateral pulmonary artery stenting due to occluded femoral veins

2017 ◽  
Vol 28 (2) ◽  
pp. 341-343
Author(s):  
Sreeja Pavithran ◽  
Ramyashri Chandrasekaran ◽  
Kothandam Sivakumar
Keyword(s):  
Pulmonary Artery ◽  
Arterial Switch Operation ◽  
Hepatic Veins ◽  
Caval Vein ◽  
Jugular Veins ◽  
Arterial Switch ◽  
Inferior Caval Vein ◽  
Switch Operation ◽  
Alternative Routes ◽  
Transhepatic Access

AbstractWhen the inferior caval vein is occluded or abnormal, jugular and hepatic veins provide alternative routes for interventions. For pulmonary artery stenting, transhepatic access may give a relatively straighter route than that from the jugular veins. We describe the challenges and strategies during transhepatic bilateral pulmonary artery stenting after arterial switch operation complicated by occluded inferior caval vein and congested hepatic veins.

Abnormal Pulmonary Artery Bending Correlates With Increased Right Ventricular Afterload Following the Arterial Switch Operation

2019 ◽  
Vol 10 (5) ◽  
pp. 572-581 ◽  
Author(s):  
Yue-Hin Loke ◽  
Francesco Capuano ◽  
Jason Mandell ◽  
Russell R. Cross ◽  
Ileen Cronin ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Arterial Switch Operation ◽  
Pulmonary Arteries ◽  
Three Dimensional ◽  
Radius Of Curvature ◽  
Transposition Of Great Arteries ◽  
Arterial Switch ◽  
Ventricular Afterload ◽  
Switch Operation

Purpose: In transposition of great arteries, increased right ventricular (RV) afterload is observed following arterial switch operation (ASO), which is not always related to pulmonary artery (PA) stenosis. We hypothesize that abnormal PA bending from the Lecompte maneuver may affect RV afterload in the absence of stenosis. Thus, we sought to identify novel measurements of three-dimensional cardiac magnetic resonance (CMR) images of the pulmonary arteries and compare with conventional measurements in their ability to predict RV afterload. Methods: Conventional measurements and novel measurements of the pulmonary arteries were performed using CMR data from 42 ASO patients and 13 age-matched controls. Novel measurements included bending angle, normalized radius of curvature ( Rc), and normalized weighted radius of curvature ( Rc- w). Right ventricular systolic pressures (as the surrogate for RV afterload) were measured by either recent echocardiogram or cardiac catheterization. Results: Conventional measurements of proximal PA size correlated with differential pulmonary blood flow ( r = 0.49, P = .001), but not with RV peak systolic pressures ( r = −0.26, P = .18). In ASO patients, Rc- w correlated with higher RV systolic pressures ( r = −0.57, P = .002). Larger neoaortic areas and rightward bending angles correlated with smaller right pulmonary artery Rc ( r = −0.48, P = .001; r = 0.41, P = .01, respectively). Finally, both pulmonary arteries had significantly smaller Rc compared to normal controls. Conclusions: Pulmonary arteries exhibit abnormal bends following ASO that correlate with increased RV afterload, independent of PA stenosis. Future work should focus on clinical and hemodynamic contributions of these shape parameters.

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