d-Transposition of the Great Arteries (Atrial Switch)

Abstract Background A systemic right ventricle (RV) after atrial switch in transposition of the great arteries (TGA) or congenitally corrected TGA (ccTGA) often results in advanced heart failure in adulthood. Case summary Four patients with INTERMACS Class III underwent durable ventricular assist device (VAD) implantation for a systemic RV. Two patients were diagnosed with ccTGA and underwent tricuspid valve replacement, and two were diagnosed with TGA in childhood and underwent Mustard repair. The two patients with ccTGA received an EVAHEART (Sun Medical, Nagano, Japan) and HeartMate 3 (Abbott Laboratories, Abbott Park, IL, USA) at the age of 56 years and 34 years, respectively. Of the patients with TGA, one received a Heartmate II at age 40 years, and one received a HeartMate 3 at age 40 years. All patients were weaned from cardiopulmonary bypass without subpulmonic VAD support and transferred to the intensive care unit with optimum VAD support. No in-hospital deaths, cerebrovascular accidents, or other major complications occurred. The post-VAD right heart catheter study showed a remarkable reduction in pulmonary capillary wedge pressure in all patients. Discussion The indications for and surgical technique of durable VAD implantation for a systemic RV after atrial switch of TGA or ccTGA have not been fully established. A durable VAD, including the HeartMate 3, was successfully implanted in four such patients in this study. Pre-operative three-dimensional computed tomography images and intraoperative transoesophageal echocardiography guidance helped to determine the positions of the inflow and pump.

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The atrial switch patient with a dilated subpulmonic left ventricle

International Journal of Cardiology Congenital Heart Disease ◽

10.1016/j.ijcchd.2021.100153 ◽

2021 ◽

pp. 100153

Author(s):

Sumeet S. Vaikunth ◽

Christiane Haeffele ◽

Doff B. McElhinney ◽

George K. Lui ◽

Anitra W. Romfh

Keyword(s):

Left Ventricle ◽

Atrial Switch

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The right ventricle shows distinct wall motion characteristics in L-TGA vs. D-TGA/atrial switch

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/1532-429x-11-s1-p28 ◽

2009 ◽

Vol 11 (S1) ◽

Author(s):

Michelle Savacool ◽

Philip Kilner ◽

David Sahn ◽

Willem Helbing ◽

Harold Litt ◽

...

Keyword(s):

Right Ventricle ◽

Wall Motion ◽

Atrial Switch ◽

Motion Characteristics ◽

The Right

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Problems in the diagnosis of discordant atrioventricular with concordant ventriculo-arterial connections: anatomical considerations, surgical management, and long-term outcome

Cardiology in the Young ◽

10.1017/s1047951115000736 ◽

2015 ◽

Vol 26 (1) ◽

pp. 127-138 ◽

Cited By ~ 1

Author(s):

Daniela Laux ◽

Lucile Houyel ◽

Fanny Bajolle ◽

Francesca Raimondi ◽

Younes Boudjemline ◽

...

Keyword(s):

Surgical Management ◽

Heart Defects ◽

Pacemaker Implantation ◽

Heterotaxy Syndrome ◽

Term Outcome ◽

Long Term Outcome ◽

Atrial Switch ◽

Great Vessels

AbstractBackgroundDiscordant atrioventricular with concordant ventriculo-arterial connections is a rare cardiac defect. When isolated, the haemodynamics resemble transposition of the great arteries. In complex heart defects such as heterotaxy, haemodynamics guide the surgical approach.ObjectiveTo report a series of eight patients with discordant atrioventricular and concordant ventriculo-arterial connections focussing on anatomical and diagnostic difficulties, surgical management, and follow-up.MethodsA retrospective review was carried out from 1983 to 2013. Anatomical description was based on segmental analysis. Emphasis was placed on the venoatrial connections.ResultsSegmental arrangement was {I, D, S} in six patients, all with spiralling great vessels. There were two patients with parallel great vessels of whom one had {S, L, D} and the other had {S, L, A} arrangement. Of eight patients, five had heterotaxy syndrome. Median age at repair surgery was 1.4 years (with a range from 1.1 months to 8.1 years). The repair surgery finally performed was the atrial switch procedure in seven out of eight patients. The main post-operative complications were two cases of baffle obstruction and one sick sinus syndrome needing pacemaker implantation. There were two early post-operative deaths and six late survivors. Median follow-up was 4.2 years (with a range from 3.9 to 26.7 years) with good functional status in all survivors.DiscussionDiagnosing discordant atrioventricular with concordant ventriculo-arterial connections remains challenging. There are ongoing controversies about the definition of atrial morphology and heterotaxy syndrome animating the anatomic discussion of these complex heart defects. Haemodynamically, the atrial switch procedure is the surgical method of choice with an encouraging long-term follow-up despite rhythm disturbances and baffle obstruction.

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