Coronary Artery Morphology and Function Late after Neonatal Arterial Switch Operation (ASO) for Transposition of the Great Arteries (TGA)—A Cardiac Magnetic Resonance (CMR) Study and Follow-up Recommendations

Background: Accurate coronary translocation is very important for a successful arterial switch operation (ASO) for transposition of the great arteries (TGA) and to provide good long-term outcomes. We have previously reported the “bay window” technique as a useful option for coronary translocation with excellent midterm results. However, the long-term results of this technique and the morphological changes in the coronary channel have not yet been reported. Patients and Methods: Between September 2001 and December 2012, 33 patients with TGA underwent coronary translocation using the bay window technique concomitantly with ASO. The diagnoses were TGA with intact ventricular septum in 21, TGA with ventricular septal defect in 7, and Taussig-Bing anomaly in 5. The median age of the patients at operation was 12 days, and their median body weight was 2.93 kg. Coronary artery patterns were as follows: Shaher and Puddu’s type 1 in 23, single coronary artery in 4, intramural type in 1, and others in 5. Results: The median follow-up period was 4.5 years. There were no operative deaths, but there was one late death because of sepsis 13 months after ASO. Coronary artery evaluation with angiography, computed tomography, or myocardial scintigraphy was performed in 22 patients. There was no abnormal coronary morphology or perfusion. Coronary channel dilatation was not observed. Three patients underwent reoperation for pulmonary stenosis. Conclusions: The bay window technique provides excellent long-term results in ASO for TGA. Three-dimensional computed tomography revealed no aneurysmal changes in the bay window channel at nine-year follow-up examination.

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Stenosis of the branches of the neopulmonary artery after the arterial switch operation: A cardiac magnetic resonance imaging study

Annals of Pediatric Cardiology ◽

10.4103/0974-2069.107230 ◽

2013 ◽

Vol 6 (1) ◽

pp. 29

Author(s):

Boban Thomas ◽

JoséDiogo Ferreira Martins ◽

NunoJalles Tavares ◽

Artur Lopes ◽

FátimaF Pinto ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Cardiac Magnetic Resonance Imaging ◽

Arterial Switch Operation ◽

Imaging Study ◽

Magnetic Resonance Imaging Study ◽

Resonance Imaging ◽

Arterial Switch ◽

Switch Operation

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Alternative pulmonary artery reconstruction technique in the arterial switch operation

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezab049 ◽

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.

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Single coronary artery and neonatal arterial switch operation: early and long-term outcomes†

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezx046 ◽

2017 ◽

Vol 52 (1) ◽

pp. 90-95 ◽

Cited By ~ 7

Author(s):

Sébastien Gerelli ◽

Margaux Pontailler ◽

Bruno Rochas ◽

Emanuela Angeli ◽

Mathieu Van Steenberghe ◽

...

Keyword(s):

Coronary Artery ◽

Arterial Switch Operation ◽

Single Coronary Artery ◽

Long Term Outcomes ◽

Arterial Switch ◽

Switch Operation

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Abstract 14744: Native Bicuspid Pulmonary Valve in D-loop Transposition of the Great Arteries: Outcomes of the Neo-aortic Valve Function and Root Dilation After Arterial Switch Operation

Circulation ◽

10.1161/circ.142.suppl_3.14744 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jane Margaret Irwin ◽

Geoffrey Binney ◽

Kimberlee Gauvreau ◽

Sitaram Emani ◽

Elizabeth Blume ◽

...

Keyword(s):

Aortic Valve ◽

Pulmonary Valve ◽

Arterial Switch Operation ◽

Arterial Switch ◽

Switch Operation ◽

Significant Difference ◽

First Occurrence ◽

D Loop

Introduction: Neo-aortic root dilation (ARD) is common after arterial switch operation (ASO) for D-loop transposition of the great arteries (TGA). We sought to compare short and long-term outcomes for bicuspid native pulmonary valve (BNPV) patients to those with normal trileaflet variants (TNPV). Methods: A retrospective cohort of TGA patients undergoing ASO at Boston Children’s Hospital from 1989-2018 was analyzed, matching BNPV patients 1:3 with TNPV patients by year of ASO; those with >mild subpulmonary stenosis or complex TGA were excluded. Categorical and continuous variables were compared using Fisher’s exact and Wilcoxon rank sum tests, respectively. Kaplan-Meier analyses with log-rank test compared groups for time to first reoperation on the neo-aortic valve, first occurrence of ≥moderate neo-aortic regurgitation (AR), and ARD defined as root z-score ≥4. Hazard ratios were estimated based on the Cox proportional hazards model. Results: A total of 83 BNPV patients were matched with 217 TNPV. BNPV patients were more likely to have a VSD (75% vs 44%, p <0.001). Early surgical outcomes including hospital LOS (11 vs 10 days) and 30-day mortality (3.6% vs 2.8%) were similar. During median 10 years follow-up, neo-aortic valve reoperation occurred in 4 BNPV (6%) vs 6 TNPV (3%) patients, with no statistically significant difference in time to reoperation. More BNPV patients had AR at discharge (4.9% vs 0%, p=0.014) and during follow-up (13.4% vs 4.3%, HR 3.9, p=0.004), with shorter time to first occurrence of AR (Figure 1A); this remained significant after adjusting for presence of VSD. Similarly, ARD was more common in BNPV (45% vs 37%, HR 1.64, p=0.02) with shorter time to first occurrence (Figure 1B). Conclusions: While patients with BNPV have similar short-term ASO outcomes, AR and ARD occur more frequently and earlier compared with TNPV patients. Further long-term studies are needed to determine whether this results in greater need for neo-aortic valve reoperation.

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