scholarly journals Midterm results after complete surgical correction of transposition of the great arteries

2014 ◽  
Vol 142 (5-6) ◽  
pp. 306-313 ◽  
Author(s):  
Vojislav Parezanovic ◽  
Mirko Mrdjen ◽  
Slobodan Ilic ◽  
Irena Vulicevic ◽  
Milan Djukic ◽  
...  
Keyword(s):  
Heart Failure ◽  
Arterial Switch Operation ◽  
Clinical Signs ◽  
Late Complications ◽  
Surgical Correction ◽  
Complex Congenital Heart Disease ◽  
Transposition Of Great Arteries ◽  
Arterial Switch ◽  
Switch Operation

Introduction. Arterial switch operation (ASO) is a cardiosurgical method of choice for complete anatomical correction of transposition of great arteries. Improvement of this procedure has made considerably improved the outcome and long-term prognosis of children born with this complex congenital heart disease. Objective. The aim of this study was to estimate the success rate of ASO through retrospective analysis of mortality and late complications. Methods. This study included 57 children operated from 1st January 2005 until 31st December 2009. Parameters that could influence the outcome of surgery were investigated. The following late complications were investigated: neopulmonary artery stenosis, neoaortic stenosis and regurgitation, as well as clinical signs of heart failure. Results. Early postoperative mortality was 15.8% (9/57 patients). During follow-up (8 to 72 months, average 36.5 months) there were no lethal outcomes. On the last echocardiography examination, 73.2% patients had neoaortic regurgitation and 67.4% patients had neopulmonary regurgitation, but all of them were mild in intensity. Neopulmonary stenosis had 32.6% of patients, but only two had moderate or severe stenosis. No one had ischemic ECG changes. Three reinterventions were performed due to serious residual problems: surgical correction of neoaortic stenosis, surgical correction of neopulmonary stenosis and transcatether balloon dilatation for aortic recoarctation. At the end of the follow-up period, only one of 46 consistently followed patients had signs of heart failure which required therapy (2.2%), while the majority of patients were without any symptoms and with good effort tolerance. Conclusion. Arterial switch operation has been successfully performed at our institution, with acceptable perioperative mortality and excellent late outcome.

Alternative pulmonary artery reconstruction technique in the arterial switch operation

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.

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 Lately Performed Arterial Switch Operation in a Three Years Old Child Diagnosed of Transposition of Great Arteries

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Huseyin Avni Solgun
Keyword(s):  
Septal Defect ◽  
Arterial Switch Operation ◽  
Pulmonary Arteries ◽  
Transposition Of Great Arteries ◽  
Case Presentation ◽  
Arterial Switch ◽  
Switch Operation ◽  
Atrial Switch ◽  
Atrial Switch Operation

Bacground: Insidans for transposition of great arterieas(TGA) is %0.5-1 of all congential hearth diseases. There is reverse output of aorta and pulmonary arteries in hearth ventricules. Additionally there is ventriculer septal defect(VSD) in %25 of TGA patients. In some infants there can be either left ventriculer outflow tract stenosis. Arterial switch (Jaten) operation is current accepted procedure for TGA treatment. Case presentation: The Patient with the symptom of severe syanosis from birth have been diagnosed as TGA, VSD and ASD with pediatric cardiology examination in an extarnal hospital. After a withut follow-up period; when 34 months age the patient applicated to our institute hospital by the complains of severe synosis and reduction of effort capacity. According to ecocardiography and angiograghy findings, Arterial switch operation(AS) planned and performed even late age of patient. Conclusion: Generally; AS in TGA patients is prefered to be done in the first month of life. In literature there is very rare cases presented in early childhood patients. In respect to this knowledge we presented a succesful atrial switch operation in three years old patient.

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.

Abstract 16754: Novel Characterization of Pulmonary Artery Bending, Rather Than Stenosis, Detects Increased Right Ventricular Afterload and is Associated With Increased Right Ventricular Mass in the Post-Arterial Switch Operation Heart

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Marc A Delaney ◽  
Paige Mass ◽  
Francesco Capuano ◽  
Yue-hin Loke ◽  
Laura Olivieri
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Arterial Switch Operation ◽  
Radius Of Curvature ◽  
Transposition Of Great Arteries ◽  
Arterial Switch ◽  
Switch Operation

Introduction: Surgical treatment of transposition of great arteries involves the Arterial Switch Operation (ASO) and the LeCompte maneuver, where the pulmonary artery (PA) and its bifurcation are translocated anterior to the neoaortic root, creating relative PA stenosis and exaggerated PA bending. Assessment of branch PA dimensions can identify stenosis, however complex 3-dimensional bending without clear stenosis may contribute to elevated right ventricular (RV) afterload. Initial data suggest elevated RV afterload and RV mass are prevalent in these patients but the etiology and associated risk factors remain unclear. Hypothesis: In post-ASO patients, more extreme PA bending, as described by radius of curvature, will be associated with elevated RV afterload and RV mass independently of relative PA stenosis. Methods: Retrospective single-center analysis of 22 post-ASO patients was performed, representing native anatomy of D-TGA with (15, 68%) and without (7, 32%) intact ventricular septum, excluding those with PA stent, pulmonary hypertension, or other anatomical confounders. RV systolic pressure (RVSP) was recorded from echocardiography (11, 50%) or catheterization (11, 50%) and correlated to cardiac magnetic resonance (CMR) imaging measurements including: radius of curvature (Rcw) weighted to differential pulmonary blood flow and RV mass indexed to body surface area. Results: In ASO patients, receiver operating characteristic curve demonstrated Rcw, but not PA stenosis, moderately detected presence of elevated RVSP (>40 mmHg) (respectively: AUC 0.84, p = 0.03 and AUC 0.49, p =0.60). Patients with elevated RV Mass had more extreme Rcw (when normalized to body surface area), but no difference in PA stenosis via Nakata index (respectively: p = 0.10, p = 0.02). Conclusions: Abnormal PA bending as described by Rcw is associated with increased RV afterload and RV Mass. Rcw may serve as a promising future clinical proxy to RV afterload.

Arrhythmias after surgical correction of complete transposition—follow-up into adolescence

1996 ◽  
Vol 6 (2) ◽  
pp. 156-161 ◽  
Author(s):  
Paul A. Hutter ◽  
Menno W. Baars ◽  
Karin T. den Boer ◽  
Ronald F. F. van den Haak ◽  
Eric Harinck ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Heart Defects ◽  
Arterial Switch Operation ◽  
Pacemaker Implantation ◽  
Arterial Switch ◽  
Complete Transposition ◽  
Natural Progression ◽  
Switch Operation ◽  
Ventricular Tachycardias

SummaryThe long-term natural progression of cardiac rhythm and the incidence of serious arrhythmias in relation to previous procedures and associated heart defects were studied in a group of 76 patients after an arterial switch operation for complete transposition and compared to a group of 24 patients who had undergone intraatrial corrections (Mustard or Senning operation). Standard and 24-hour ambulatory electrocardiograms were reviewed. Mean follow-up was 7.9 years (range 2-16) after an arterial switch and 15.2 years (range 6-26) following the Mustard or Senning procedures. One patient died after an arterial switch from pulmonary hypertension (age 9.9 years), and three patients died suddenly, presumably from arrhythmias, following atrial redirection procedures (ages 13, 18 and 20 years). Symptomatic arrhythmias were not seen after the arterial switch operation. Three patients required pacemaker implantation after atrial redirection, and a further two required medication to control tachyarrhythmias. Survival analysis of sequential electrocardiograms showed a mean maintenance of sinus rhythm during 12.9 years (95% confidence interval 11.4-14.5) after the arterial switch and 9.0 years (7.3-10.7) after atrial procedures (p=0.003). Development of heart rate was significantly different (p=0.001), with higher rates in adolescents after an arterial switch. Twenty-four-hour recordings were abnormal in five of 72 patients following arterial correction, disclosing excessive ventricular extrasystoles in four (three monomorphic, one polymorphic) and a wandering pacemaker in one. After atrial procedures, 11 of 19 were abnormal (p<0.001), with sinus or atrial bradycardia in eight, atrial flutter in two, and monomorphic ventricular tachycardias in one. Abnormal findings on either 12-lead or 24-hour electrocardiograms were seen in 22% of patients following an arterial switch procedure and 83% of patients undergoing atrial redirection (p<0.001). Sinus rhythm, therefore, is preserved longer and arrhythmias are less frequent and less severe after the arterial switch operation than after the Mustard or Senning operations.

scholarly journals Mid-term follow-up of neoaortic regurgitation after the arterial switch operation for transposition of the great arteries☆

2006 ◽  
Vol 29 (2) ◽  
pp. 162-167 ◽  
Author(s):  
Ho Young Hwang ◽  
Woong-Han Kim ◽  
Jae Gun Kwak ◽  
Jeong Ryul Lee ◽  
Yong Jin Kim ◽  
...  
Keyword(s):  
Arterial Switch Operation ◽  
Arterial Switch ◽  
Switch Operation
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