Arterial switch operation in patients with transposition and a left-sided aorta

2017 ◽  
Vol 27 (9) ◽  
pp. 1771-1777
Author(s):  
Sachin Talwar ◽  
Robert H. Anderson ◽  
Pradeep Ramakrishnan ◽  
Amolkumar Bhoje ◽  
Saurabh Gupta ◽  
...  
Keyword(s):  
Ventricular Function ◽  
Arterial Switch Operation ◽  
Nyha Class ◽  
Sudden Onset ◽  
Left Ventricular ◽  
Aortic Cross Clamp Time ◽  
Arterial Switch ◽  
Switch Operation ◽  
The Mean

AbstractObjectivesArterial switch operation is the treatment of choice in infants with transposed arterial trunks. It is technically challenging to perform in patients having usual atrial arrangement and concordant atrioventricular connections but having a left-sided aorta. Correction in this setting requires surgical expertise and precision. Here we review our experience with such patients.MethodsBetween January, 2002 and October, 2013, the arterial switch operation was performed in 20 patients in the combination emphasised above. Patient records were analysed in detail for coronary arterial patterns, and for the techniques used for transfer of the coronary arteries and reconstruction of the great arteries. Outcomes were recorded in terms of in-hospital survival and left ventricular function at the most recent follow-up.ResultsAll patients survived the procedure. Ages ranged from 3 days to 18 months, with a median of 75 days; the weight of the patients ranged from 3 to 8.8 kg, with a median of 3.85 kg. The LeCompte manoeuvre was performed in only nine patients. The mean cardiopulmonary bypass time was 157.5±24.9, with a median of 161 minutes, and the mean aortic cross-clamp time was 101.2±23.8, with a median of 102 minutes. Subsequently, two patients died: the first due to a sudden onset of ventricular fibrillation and the second during a crisis of severe pulmonary hypertension. At the last follow-up, which ranged from 23 to 41 months, with a mean of 38.04±2.32 and a median of 38.4 months, all 18 survivors were in NYHA class I, with none requiring cardiac medications and all having normal bi-ventricular function without residual defects.ConclusionWith appropriate technical modifications, patients with concordant atrioventricular and discordant ventriculo-arterial connections with a left-sided aorta can undergo successful anatomical repair.

scholarly journals Late Outcome After Arterial Switch Operation for Transposition of the Great Arteries

Circulation ◽  
2001 ◽  
Vol 104 (suppl_1) ◽  
Author(s):  
J. Losay ◽  
A. Touchot ◽  
A. Serraf ◽  
A. Litvinova ◽  
V. Lambert ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Hazard Function ◽  
Arterial Switch Operation ◽  
Left Ventricular ◽  
Late Outcome ◽  
Late Mortality ◽  
Late Death ◽  
Arterial Switch ◽  
Switch Operation

Background Early and midterm results of the arterial switch operation (ASO) in transposition of the great arteries (TGA) are good, but late outcome data in large populations are still few. Methods and Results Twelve hundred patients had an ASO for TGA between 1982 and 1999, with prospective follow-up of 1095 survivors. Outcome measures included late death, reoperation, aortic insufficiency (AI), pulmonary stenosis (PS), and coronary anomaly. Median follow-up was 4.9 years (range 0.5 to 17 years). Late death occurred in 32 patients; survival was 88% at both 10 and 15 years. The hazard function for death declined rapidly, with no deaths after 5 years. Late mortality was correlated with reintervention and major events in the intensive care unit. Reoperation was performed in 103 patients, more often in complex TGA; the cause was mainly PS. Freedom from reintervention was 82% at 10 and 15 years, with a hazard function that declined rapidly but slowly increased after 3 years. At the last follow-up, PS was present in 3.9% of patients, and grade II or more AI was present in 3.2%, with a cumulative incidence of 9% at 15 years. Among the 278 patients who had a coronary arteriography, 8% had coronary lesions. Normal left ventricle and sinus rhythm were seen in 96.4% and 98.1%, respectively. Conclusions Fifteen years after ASO, late mortality was low, with no deaths after 5 years; reoperation, mainly owing to PS, occurred throughout the follow-up. AI and coronary obstruction are rare but warrant further follow-up. Good left ventricular function and sinus rhythm are maintained.

scholarly journals Delayed Arterial Switch Operation in a Three Year Old Child with Transposition Of Great Arteries

2019 ◽  
Author(s):  
Huseyin Avni Solğun ◽  
Farid Gojayev
Keyword(s):  
Heart Diseases ◽  
Arterial Switch Operation ◽  
Pulmonary Arteries ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Transposition Of Great Arteries ◽  
Arterial Switch ◽  
Switch Operation ◽  
Atrial Switch Operation

Abstract Background: The incidence of transposition of the great arteries (TGA) is 0.5-1% of all congenital heart diseases. The aorta and pulmonary arteries exit inversely from the heart ventricles. In addition, 25% of TGA patients have ventricular septal defect (VSD). Some infants may have left ventricular outflow tract obstruction. Arterial switch (Jaten) operation is the accepted procedure for the treatment of TGA. Case report: The patient had congenital severe cyanosis and was diagnosed as TGA, VSD and ASD after a pediatric cardiology examination. The patient went to follow-up for a short time and did not go to follow-up and admitted to our institute with complaints of severe cyanosis and decreased exercise capacity at the age of 34 months. According to echocardiography and angiography findings, arterial switch operation (AS) was planned for treatment despite delayed treatment.Conclusion: In general; it is preferable to perform AS in the first month of life in patients with TGA. There is very rare information in the literature about the preferability of early childhood patients. In the light of this information, we present a case of successful atrial switch operation in a three-year-old patient.

scholarly journals Impact of pulmonary artery reduction during arterial switch operation: 14 years follow-up

2020 ◽  
Vol 30 (6) ◽  
pp. 917-924
Author(s):  
Fernanda Lübe Antunes Pereira ◽  
Cristiane Nunes Martins ◽  
Roberto Max Lopes ◽  
Matheus Ferber Drummond ◽  
Fernando Antonio Fantini ◽  
...  
Keyword(s):  
Arterial Switch Operation ◽  
Z Score ◽  
Valve Regurgitation ◽  
Arterial Switch ◽  
Switch Operation ◽  
Long Term Follow Up ◽  
Z Scores ◽  
The Mean

Abstract OBJECTIVES Pulmonary artery/aorta (PA/Ao) size discrepancy plays an important role in the development of neoaortic root growth and valve regurgitation. Since 2004, we started using PA reduction to manage severe great vessels root mismatch at the time of arterial switch operation. The purpose of this study is to evaluate the impact of this technique in the mid- and long-term follow-up. METHODS Patients considered to have severe PA/Ao mismatch (>2:1 ratio) underwent resection of a 3- to 4-mm flap of the posterior PA wall. Patients submitted to this technique were followed up with clinical and image examinations. Echocardiographic findings were reviewed, and Z-scores were recorded to evaluate the incidence and progression of neoaortic root dilatation and valve regurgitation. RESULTS The median (Q1–Q3) follow-up time was 8 years (3–11). Before arterial switch operation, the median (Q1–Q3) Z-score of the PA annulus was 2.90 (2.75–3.75). At the latest follow-up, the median Z-score of the neoaortic annulus was 1.34 (0.95–1.66). The mean difference between the Z-scores of PA annulus and neoaortic annulus was 1.56 (P < 0.0001). The mean value of the sinus of Valsalva was +0.29 ± 1, that of sinotubular junction was +0.71 ± 0.6 and that of ascending Ao was +1.09 ± 0.7. There was no severe dilatation of the neoaortic annulus, neoaortic root or ascending Ao during follow-up. Neoaortic valve regurgitation was none or mild in 93% of patients. CONCLUSIONS PA reduction proved to be a feasible and low-risk procedure to approach PA/Ao mismatch in arterial switch operation. Mid- and long-term follow-up showed a tendency towards stabilization of the neoaortic root dilatation and satisfactory valve performance after the procedure. Further investigation is required with a larger population and longer-term follow-up.

Two-Stage Arterial Switch Operation: Is Late Ever Too Late?

2002 ◽  
Vol 10 (3) ◽  
pp. 235-239 ◽  
Author(s):  
Howaida O Al Qethamy ◽  
Khawar Aizaz ◽  
Saber AR Aboelnazar ◽  
Samina Hijab ◽  
Yahya Al Faraidi
Keyword(s):  
Septal Defect ◽  
Arterial Switch Operation ◽  
Left Ventricular ◽  
Subaortic Stenosis ◽  
Two Stage ◽  
Actuarial Survival ◽  
Mortality And Morbidity ◽  
Arterial Switch ◽  
Switch Operation

Results of the two-stage arterial switch operation in 49 patients with transposition of the great arteries, performed between January 1995 and September 2000, were reviewed retrospectively. Twenty-one patients had a ventricular septal defect. Anatomical correction was carried out 21.89 ± 9.86 months after pulmonary artery banding, with or without a modified Blalock-Taussig shunt. Hospital mortality was 8% (4 patients). During follow-up of 30.12 ± 14.38 months, there was 1 late death and 1 patient required reoperation for pseudoaneurysm of the ascending aorta. Actuarial survival and freedom from reoperation at 5 years were 90% and 97%, respectively. Late anatomic correction (> 6 months) after the preliminary procedure can be performed with an acceptable mortality and morbidity, but undue delay may lead to left ventricular dysfunction, arrhythmias, and new aortic valve regurgitation or subaortic stenosis.

scholarly journals Evaluation of Left Ventricular Function Long Term After Arterial Switch Operation for Transposition of the Great Arteries

2018 ◽  
Vol 40 (1) ◽  
pp. 188-193 ◽  
Author(s):  
S. W. van Wijk ◽  
M. M. P. Driessen ◽  
F. J. Meijboom ◽  
T. Takken ◽  
P. A. Doevendans ◽  
...  
Keyword(s):  
Left Ventricular Function ◽  
Ventricular Function ◽  
Arterial Switch Operation ◽  
Left Ventricular ◽  
Arterial Switch ◽  
Switch Operation

Quality of Life after Children Undergo a Radical Arterial Switch Operation at an Older Age

2012 ◽  
Vol 15 (2) ◽  
pp. 103 ◽  
Author(s):  
Jing-bin Huang ◽  
Yong-tao Cao ◽  
Jian Liang ◽  
Xiao-dong Lv
Keyword(s):  
Quality Of Life ◽  
Arterial Switch Operation ◽  
Older Age ◽  
Healthy Population ◽  
Healthy Children ◽  
Arterial Switch ◽  
Switch Operation ◽  
The Mean

<p><b>Objective:</b> The goal of the study was to evaluate the quality of life of children after the older corrective arterial switch operation (ASO) by means of the Pediatric Quality of Life Inventory (PedsQL), version 4.0.</p><p><b>Methods:</b> The records of 86 patients who had complete transposition of the great arteries plus a nonrestrictive ventricular septal defect, or a Taussig-Bing anomaly, and severe pulmonary arterial hypertension, and who underwent a corrective ASO at an older age (>6 months) between May 2000 and October 2008 were reviewed retrospectively. Eighty survivors were followed up, and the health-related quality of life of the survivors was evaluated with the PedsQL, version 4.0.</p><p><b>Results:</b> There were 6 hospital deaths. The mean (SD) follow-up interval was 3.5 � 2.3 years, and the mean age at last visit was 7.0 � 1.2 years. Two late deaths occurred, and 8 patients were lost to follow-up. Patients who underwent a corrective ASO at an older age showed acceptable scores for all scales, and they were all comparable with those of a healthy population.</p><p><b>Conclusions:</b> Our data suggest that the quality of life of children who undergo a corrective ASO at an older age (>6 months) is acceptable, compared with that of healthy children in China.</p>

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