Management considerations in the adult with surgically modified d-transposition of the great arteries

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318833
Author(s):  
Lasya Gaur ◽  
Ari Cedars ◽  
Gerhard Paul Diller ◽  
Shelby Kutty ◽  
Stefan Orwat
Keyword(s):  
Right Ventricle ◽  
Multimodality Imaging ◽  
Imaging Techniques ◽  
Arterial Switch Operation ◽  
Cross Sectional ◽  
Systemic Right Ventricle ◽  
Switch Operation ◽  
Cardiovascular Morbidity And Mortality ◽  
Near Term

Dextro-transposition of the great arteries (D-TGA) has undergone a significant evolution in surgical repair, leading to survivors with vastly different postsurgical anatomy which in turn guides their long-term cardiovascular morbidity and mortality. Atrial switch repair survivors are limited by a right ventricle in the systemic position, arrhythmia and atrial baffles prone to obstruction or leak. Functional assessment of the systemic right ventricle is complex, requiring multimodality imaging to include specialised echocardiography and cross-sectional imaging (MRI and CT). In the current era, most neonates undergo the arterial switch operation with increasing understanding of near-term and long-term outcomes specific to their cardiac anatomy. Long-term observations of the Lecompte manoeuvre or coronary stenoses following transfer continue, with evolving understanding to improve surveillance. Ultimately, an understanding of postsurgical anatomy, specialised imaging techniques and interventional and electrophysiological procedures is essential to comprehensive care of D-TGA survivors.

Functional assessment of the heart after corrective surgery for complete transposition

1991 ◽  
Vol 1 (1) ◽  
pp. 84-90 ◽  
Author(s):  
Andrew N. Redington
Keyword(s):  
Right Ventricle ◽  
Functional Assessment ◽  
Functional Performance ◽  
Arterial Switch Operation ◽  
Corrective Surgery ◽  
Arterial Switch ◽  
Complete Transposition ◽  
Switch Operation ◽  
The Right

SummaryThe justification for the introduction of the arterial switch procedure was based, primarily, on concern regarding the long-term ability of the right ventricle to perform as the systemic pumping chamber. In this article, the functional performance of both the systemic and pulmonary ventricles after atrial redirection procedures and the arterial switch operation will be discussed.

scholarly journals Neoaortic Regurgitation in Patients with Transposition Long Term After an Arterial Switch Operation and Its Relation to the Root Diameters and Surgical Technique Used

2019 ◽  
Vol 41 (1) ◽  
pp. 31-37 ◽  
Author(s):  
Krzysztof W. Michalak ◽  
Katarzyna Sobczak-Budlewska ◽  
Jacek J. Moll ◽  
Konrad Szymczyk ◽  
Jadwiga A. Moll ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Surgical Technique ◽  
Transthoracic Echocardiography ◽  
Multimodality Imaging ◽  
Arterial Switch Operation ◽  
Resonance Imaging ◽  
Arterial Switch ◽  
Switch Operation

Abstract Neoaortic regurgitation and root dilatation are common findings in patients with transposition after an arterial switch operation. The aim of this study was to describe the relation between neoaortic regurgitation long term after an arterial switch procedure, aortic root diameters, and surgical technique used. We also assessed the agreement of the neoaortic regurgitation grade and root diameters in different imaging modalities. For this retrospective study, we qualified 56 consecutive patients who, according to our institutional protocol, had a routine postoperative evaluation of more than 16 years with multimodality imaging studies. Neoaortic regurgitation was assessed by both transthoracic echocardiography and magnetic resonance imaging, and the root diameters obtained by echocardiography and tomography were compared to the reference values and associated with the presence of neoaortic insufficiency. Neoaortic insufficiency was present in 75% of examined patients; the vast majority of them had trace or mild regurgitation, and its qualitative evaluation was significantly different between echocardiography and magnetic resonance imaging. In our study group, the neoaortic valve and aortic sinus were larger in relation to the normal values, and they were significantly correlated with the presence of neoaortic insufficiency, but not with the surgical technique used. Values obtained by echocardiography and tomography correlated well but were significantly different. Transthoracic echocardiography has a tendency to overestimate the severity of regurgitation compared to magnetic resonance imaging. Neoaortic valve and sinus dilatation are significantly correlated with valve insufficiency, but in most cases of root dilatation, the valve remains competent.

Long-term benefits of exercise training in patients with a systemic right ventricle

2015 ◽  
Vol 179 ◽  
pp. 105-111 ◽  
Author(s):  
Teun van der Bom ◽  
Michiel M. Winter ◽  
Jennifer L. Knaake ◽  
Elena Cervi ◽  
Leonie S.C. de Vries ◽  
...  
Keyword(s):  
Exercise Training ◽  
Right Ventricle ◽  
Systemic Right Ventricle

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

2017 ◽  
Vol 52 (1) ◽  
pp. 90-95 ◽  
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

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 ◽  
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.

scholarly journals Long-term quality of life in adult survivors after the arterial switch operation

2018 ◽  
Vol 54 (6) ◽  
pp. 1001-1003 ◽  
Author(s):  
Tyson A Fricke ◽  
Benjamin R Loyer ◽  
Li Huang ◽  
Sophie Griffiths ◽  
Nima Yaftian ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Arterial Switch Operation ◽  
Adult Survivors ◽  
Arterial Switch ◽  
Switch Operation

scholarly journals The poor long-term outcomes of owl’s eye pulmonary reconstruction technique after arterial switch operation

2020 ◽  
Vol 31 (1) ◽  
pp. 113-120
Author(s):  
Mehmet Dedemoğlu ◽  
Oktay Korun ◽  
Gültekin Coşkun ◽  
Fatih Özdemir ◽  
Okan Yurdakök ◽  
...  
Keyword(s):  
Arterial Switch Operation ◽  
Reconstruction Technique ◽  
Reconstruction Method ◽  
Long Term Outcomes ◽  
Arterial Switch ◽  
Switch Operation ◽  
Significant Difference ◽  
Autologous Pericardial Patch ◽  
Group 1

Abstract OBJECTIVES This study aims to compare the early- and long-term outcomes of patients who undergo owl’s eye pulmonary artery (PA) reconstruction to those of patients who undergo conventional PA reconstruction. METHODS From January 2016 to January 2017, 64 consecutive patients underwent an arterial switch operation. The patients were divided into 2 groups in terms of neo-PA reconstruction method: 30 patients who underwent neo-PA reconstruction by owl’s eye technique were defined as group 1 and 34 patients who underwent neo-PA reconstruction by the conventional approach were defined as group 2. In the final model, after propensity matching, 23 patients from each group with similar propensity scores were included in the study. RESULTS There was no significant difference between the groups regarding patient characteristics and operative findings. In the early period, the duration of intensive care unit and hospital stays and the rate of mild neo-pulmonary stenosis (neo-PS) were significantly higher in the owl’s eye group (P = 0.04, 0.04 and 0.03). In the late period, the rate of severe neo-PS and reintervention was significantly higher in the owl’s eye group (P = 0.02 and 0.04). Furthermore, the rates of 3-year freedom from pulmonary reintervention and freedom from moderate–severe neo-PS were significantly lower in group 1 (P = 0.04). In addition, the owl’s eye reconstruction was the only factor independently related to moderate–severe neo-PS in the long term (hazard ratios = 11.2, P = 0.02). CONCLUSIONS We have abandoned the owl’s eye method for neo-PA reconstruction of the neo-PA because of serious complications. According to our series and the literature, reconstruction of the neo-PA with an oversized, pantaloon-shaped fresh autologous pericardial patch is still superior to the other techniques.

Sign in / Sign up

Export Citation Format

Share Document