scholarly journals Manajemen Perioperatif Operasi Arterial Switch pada Transposition of The Great Arteries with Intact Ventricular Septum

2020 ◽  
Vol 12 (2) ◽  
pp. 11-22
Author(s):  
Dian Kesumarini ◽  
Herdono Poernomo
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Myocardial Protection ◽  
Septal Defect ◽  
Arterial Switch Operation ◽  
Ductus Arteriosus ◽  
Intact Ventricular Septum ◽  
Arterial Switch ◽  
Switch Operation ◽  
Patent Ductus

Latar belakang: Penyakit jantung bawaan (PJB) berkontribusi terhadap hampir sepertiga dari kelainan kongenital secara keseluruhan. Transposition of the great arteries (d-TGA) adalah satu kelainan jantung bawaan (PJB) yang kompleks. Tindakan arterial switch operation (ASO) menjadi pilihan koreksi pada kasus TGA. Tindakan ini mempunyai risiko morbiditas dan mortalitas yang cukup tinggi.Kasus: Bayi berusia 42 hari dengan berat badan 3100 gram dirujuk ke Rumah Sakit Jantung dan Pembuluh Darah (RSJPD) Harapan Kita karena kelainan jantung. Pasien dilakukan diagnosik ekokardiografi dan didapatkan TGA dengan septum ventrikular yang intak (TGA-IVS), atrium septal defect (ASD) sekundum L-R shunt, dan patent ductus arteriosus (PDA). Prosedur pembedahan meliputi ASO menggunakan manuver Le Compte, pemotongan PDA, ASD ditutup sebagian dan disisakan 3mm. Durasi cardiopulmonary bypass (CPB) 136 menit dengan cross clamp 85 menit, diberikan tranfusi PRC, FFP, dan TC, lalu dipindahkan ke intensive care unit (ICU) dengan support adrenalin 0.05 mcg/kg/menit dan milrinone 0.375 mcg/kg/menit. Ekstubasi dilakukan 72 jam pascaoperasi.Pembahasan: Operasi arterial switch merupakan tindakan berisiko tinggi, dengan angka kematian dan morbiditas yang tinggi. Konsiderasi perianestesia pada pasien TGA ini di antaranya tatalaksana preanestesi, manajemen selama operasi, topangan hemodinamik, aritmia yang diakibatkan masalah pembuluh darah koroner, dan penilaian ekokardiografi epikardial pascaoperasi. Manajemen pascaoperasi penting untuk mengantisipasi efek dari CPB yang berpengaruh pada miokardium, sindroma curah jantung rendah, risiko infeksi, dan komplikasi lain yang sering terjadi pada infant setelah pembedahan ini.Kesimpulan: Manajemen preoperatif dengan mengenali faktor risiko, tatalaksana anestesia intraoperatif, myocardial protection, serta perawatan komprehensif pascaoperasi di ICU sangat menentukan outcomepasien yang menjalani prosedur ini. 

Is the function of all cardiac valves after the arterial switch operation influenced by an associated ventricular septal defect?

2011 ◽  
Vol 21 (4) ◽  
pp. 383-391
Author(s):  
J. Gabriel ◽  
H.-H. Scheld ◽  
T.D.T. Tjan ◽  
N. Osada ◽  
Thomas Krasemann
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Arterial Switch Operation ◽  
Pulmonary Stenosis ◽  
Ventricular Septum ◽  
Intact Ventricular Septum ◽  
Cardiac Valves ◽  
Arterial Switch ◽  
Switch Operation

AbstractA ventricular septal defect in transposition of the great arteries is frequently closely related to the cardiac valves. The valvar function after arterial switch operation of patients with transposition of the great arteries and ventricular septal defect or intact ventricular septum was compared. We analysed the function of all cardiac valves in patients who underwent the arterial switch operations pre- and post-operatively, 1 year after the procedure and on follow-up. The study included 92 patients – 64 with transposition of the great arteries/intact ventricular septum and 28 with transposition of the great arteries/ventricular septal defect. The median age at surgery was 5.5 days in transposition of the great arteries/intact ventricular septum (0–73 days) and 7.0 days in transposition of the great arteries/ventricular septal defect (4–41 days). Follow-up was 51.7 months in transposition of the great arteries/intact ventricular septum (3.3–177.3 months) and 55 months in transposition of the great arteries/ventricular septal defect (14.6–164.7 months). Neo-aortic, neo-pulmonary, and mitral valvar function did not differ. Tricuspid regurgitation was more frequent 1 year post-operatively in transposition of the great arteries/ventricular septal defect (n = 4) than in transposition of the great arteries/intact ventricular septum. The prevalence of neo-aortic regurgitation and pulmonary stenosis increased over time, especially in patients with transposition of the great arteries/intact ventricular septum. The presence of a ventricular septal defect in patients undergoing arterial switch operation for transposition of the great arteries only has a minor bearing for the development of valvar dysfunction on the longer follow-up.

scholarly journals Patient with D transposition of Great Arteries Operated by Senning Procedure: A Case Report

2018 ◽  
Vol 4 (1) ◽  
pp. 31-33
Author(s):  
Ashraful Hoque ◽  
Shahriar Moinuddin
Keyword(s):  
Septal Defect ◽  
Arterial Switch Operation ◽  
Ductus Arteriosus ◽  
Delayed Diagnosis ◽  
Transposition Of Great Arteries ◽  
Switch Operation ◽  
Atrial Switch ◽  
Senning Operation ◽  
Atrial Switch Operation ◽  
Patent Ductus

The atrial switch operation, the Mustard or Senning operation, for the transposition of the great arteries (TGA) was introduced in the late 1950s and was the preferred surgery for TGA until the early 1990s. The arterial switch operation has become the procedure of choice for patients with transposition of the great arteries (TGA) in most medical centres. Although atrial switching may occasionally be employed in some centres in cases with delayed diagnosis, pulmonary hypertension and some other unusual entities. We preferred to use the atrial switch operation Senning procedure for 5 months old child with TGA, small atrial septal defect (ASD) and patent ductus arteriosus (PDA).Journal of Current and Advance Medical Research 2017;4(1):31-33

scholarly journals Is arterial switch operation possible with neonatology-focused intensive care unit modality

2021 ◽  
Vol 29 (2) ◽  
pp. 136-142
Author(s):  
Onur Doyurgan ◽  
Fatih Özdemir ◽  
Osman Akdeniz ◽  
Ahmet Kuddusi İrdem ◽  
Nilüfer Matur Okur ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Arterial Switch Operation ◽  
Length Of Hospital Stay ◽  
Morbidity Rate ◽  
Median Length ◽  
Mortality And Morbidity ◽  
Arterial Switch ◽  
Switch Operation

Background: In this study, we aimed to examine the feasibility of arterial switch operation and its perioperative management with neonatology-focused intensive care modality in a region of Turkey where the birth rate and the number of asylum seekers who had to leave their country due to regional conflicts are high. Methods: Between December 2017 and June 2020, a total of 57 patients (48 males, 9 females; median age: 12.2 days; range, 2 to 50 days) who were diagnosed with transposition of the great arteries in our clinic and underwent arterial switch operation were retrospectively analyzed. All patients were followed by the neonatologist in the neonatal intensive care unit during the preoperative and postoperative period. Results: Thirty-eight (66.7%) patients had intact ventricular septum, 16 (28.1%) had ventricular septal defect, two (3.5%) had coarctation of the aorta, and one (1.7%) had Taussig-Bing anomaly. Coronary artery anomaly was present in 14 (24.5%) patients. The most common complications in the intensive care unit were renal failure requiring peritoneal dialysis in seven (12.3%) patients, supraventricular tachyarrhythmia in six (10.5%) patients, and eight (14%) patients left their chests open. The median length of stay in intensive care unit was 13.8 (range, 9 to 25) days and the median length of hospital stay was 24.5 (range, 16 to 47) days. The overall mortality rate for all patients was 12.3% (n=7). The median follow-up was 8.2 months. A pulmonary valve peak Doppler gradient of ≥36 mmHg was detected in five patients (8.7%) who were followed, and these patients were monitored by providing medical treatment. None of the patients needed reoperation or reintervention. Conclusion: We believe that arterial switch operation, one of the complex neonatal cardiac surgery, can be performed with an acceptable mortality and morbidity rate with the use of neonatology-focused intensive care modality, which is supported by pediatric cardiology and pediatric cardiac surgery.

scholarly journals Patent ductus arteriosus in preterm infants; experience of a tertiary referral neonatal intensive care unit: prevalence, complications, and management

2020 ◽  
Vol 68 (1) ◽  
Author(s):  
Reem M. Soliman ◽  
Fatma Alzahraah Mostafa ◽  
Antoine Abdelmassih ◽  
Elham Sultan ◽  
Dalia Mosallam
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Side Effects ◽  
Patent Ductus Arteriosus ◽  
Neonatal Intensive Care Unit ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Ductus Arteriosus ◽  
Patent Ductus

Abstract Background Patent ductus arteriosus poses diagnostic and therapeutic dilemma for clinicians, diagnosis of persistent PDA, and determination of its clinical and hemodynamic significance are challenging. The aim of this study is to determine the prevalence of PDA in preterm infants admitted to our NICU, to report cardiac and respiratory complications of PDA, and to study the management strategies and their subsequent outcomes. Result Echocardiography was done for 152 preterm babies admitted to neonatal intensive care unit (NICU) on day 3 of life. Eighty-seven (57.2%) preterms had PDA; 54 (62.1%) non-hemodynamically significant PDA (non-hsPDA), and 33 (37.9%) hemodynamically significant PDA. Hemodynamically significant PDA received medical treatment (paracetamol 15 mg/kg/6 h IV for 3 days). Follow-up echocadiography was done on day 7 of life. Four babies died before echo was done on day 7. Twenty babies (68.9%) achieved closure after 1st paracetamol course. Nine babies received 2nd course paracetamol. Follow-up echo done on day 11 of life showed 4 (13.7%) babies achieved successful medical closure after 2nd paracetamol course; 5 babies failed closure and were assigned for surgical ligation. The group of non-hsPDA showed spontaneous closure after conservative treatment. Pulmonary hemorrhage was significantly higher in hsPDA group. Mortality was higher in hsPDA group than non-hsPDA group. Conclusion Echocardiographic evaluation should be done for all preterms suspected clinically of having PDA. We should not expose vulnerable population of preterm infants to medication with known side effects unnecessarily; we should limit medical closure of PDA to hsPDA. Paracetamol offers several important therapeutic advantages options being well tolerated and having more favorable side effects profile.

scholarly journals Aortic Coarctation 28 Days after an Arterial Switch Operation in a Neonate

2016 ◽  
Vol 43 (4) ◽  
pp. 354-356
Author(s):  
Fumiaki Shikata ◽  
Toru Okamura ◽  
Takashi Higaki ◽  
Masahiro Okura ◽  
Ai Kojima ◽  
...  
Keyword(s):  
Pressure Gradient ◽  
Aortic Coarctation ◽  
Arterial Switch Operation ◽  
Irregular Shape ◽  
Ventricular Septum ◽  
Early Complication ◽  
Intact Ventricular Septum ◽  
Aortic Isthmus ◽  
Arterial Switch ◽  
Switch Operation

Aortic coarctation rarely occurs after an arterial switch operation for D-transposition of the great arteries with intact ventricular septum. We report the case of a neonate patient in whom aortic coarctation developed 28 days after an uncomplicated arterial switch operation. Preoperatively, the aorta was noted to have an irregular shape, but there was no pressure gradient across the lesion. The patient underwent successful reoperation to correct the coarctation. We hope that our report raises awareness of a rare early complication after arterial switch operation with intact ventricular septum, and the need to carefully monitor the aortic isthmus in patients who have aortic irregularities, even in the absence of a pressure gradient.

Prenatal diagnosis of complete transposition of the great arteries and dextrocardia in the fetus with left juxtaposition of the atrial appendages and subpulmonary ventricular septal defect

2020 ◽  
Author(s):  
I.N. Daminov
Keyword(s):  
Prenatal Diagnosis ◽  
Ventricular Septal Defect ◽  
Pulmonary Artery ◽  
Septal Defect ◽  
Arterial Switch Operation ◽  
Ductus Arteriosus ◽  
Health Improvement ◽  
Complete Transposition ◽  
Switch Operation ◽  
Third Degree Atrioventricular Block

The case of prenatal ultrasound diagnosis of complete transposition of the great arteries and dextrocardia in the fetus with left juxtaposition of the atrial appendages and subpulmonary ventricular septal defect in the third trimester is presented. The postnatal echocardiography confirmed the prenatal diagnosis. At 2 months of life, first surgical intervention under extracorporeal circulation was performed: the arterial switch operation and narrowing of the dilated pulmonary artery root, closure of patent foramen ovale, ligation of patent ductus arteriosus. At the age of 8 months, the child underwent a second operation: closure of ventricular septal defect with the transventricular approach and plastic surgery of the pulmonary artery. After an operation third-degree atrioventricular block (bradyarrhythmias) has occurred and 2 weeks later patient's health improvement was achieved, and he underwent implantation of a single-chamber pacemaker. Currently, the child is 2 years old, physical and mental development corresponds to age and he remains under the supervision of specialists.

PP-54. Evaluation of patent ductus arteriosus cases in a neonatal intensive care unit

2010 ◽  
Vol 86 ◽  
pp. S40
Author(s):  
Avyaz Aydogdu ◽  
Bilin Cetinkaya Cakmak ◽  
Ali Rahmi Bakiler ◽  
Defne Engur ◽  
Munevver Kaynak Turkmen
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patent Ductus Arteriosus ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Ductus Arteriosus ◽  
Patent Ductus
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