Successful case of neo-aortic valve replacement in the patient et late follow-up after arterial switch operation for correction of transposition of the great arteries with ventricular septal defect: the peculiarities of surgical correction

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.

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Results of the arterial switch operation for transposition of the great arteries with ventricular septal defect. Surgical considerations and midterm follow-up data.

Circulation ◽

10.1161/01.cir.80.6.1689 ◽

1989 ◽

Vol 80 (6) ◽

pp. 1689-1705 ◽

Cited By ~ 64

Author(s):

R M Di Donato ◽

G Wernovsky ◽

E P Walsh ◽

S D Colan ◽

P Lang ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Arterial Switch Operation ◽

Arterial Switch ◽

Switch Operation

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Mechanical neo-aortic valve replacement (NAVR) after arterial switch operation (ASO)

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2004-816655 ◽

2004 ◽

Vol 52 (S 1) ◽

Author(s):

W Beierlein ◽

S Salehi-Gilani ◽

W Schneider ◽

R Kaulitz ◽

M Hofbeck ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Arterial Switch Operation ◽

Arterial Switch ◽

Switch Operation

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Neo-aortic valvar function after the arterial switch

Cardiology in the Young ◽

10.1017/s1047951106000953 ◽

2006 ◽

Vol 16 (5) ◽

pp. 481-489 ◽

Cited By ~ 54

Author(s):

Bradley S. Marino ◽

Gil Wernovsky ◽

Doff B. McElhinney ◽

Abbas Jawad ◽

Dieuwertje L. Kreb ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Root ◽

Septal Defect ◽

Arterial Switch Operation ◽

Somatic Growth ◽

Double Outlet Right Ventricle ◽

Childhood And Adolescence ◽

Arterial Switch ◽

Switch Operation

Objectives: The purpose of our study was to assess the prevalence and progression, during childhood and adolescence, of dilation of the neo-aortic root, and neo-aortic valvar regurgitation, and to identify risk factors for such dilation and regurgitation, after the arterial switch operation.Methods: We included all patients who had undergone an arterial switch operation at The Children's Hospital of Philadelphia, and had been followed for a minimum of 4 years, and had at least 2 postoperative echocardiograms. Neo-aortic valvar regurgitation was quantitatively assessed, and measurements were made of the neo-aortic root at the level of the basal attachment of the leaflets, mid-sinusal level, and the sinutubular junction.Results: We found 82 patients who satisfied the criterions for inclusion, of whom 52 patients had transposition with an intact ventricular septum, and 30 had either an associated ventricular septal defect or double outlet right ventricle. The median follow-up time was 8.8 years (4.1 to 16.4 years). The neo-aortic valve had been replaced in 1 patient. Of the patients, 3 had moderate, 66 had trivial to mild, and 12 had no neo-aortic valvar regurgitation at their most recent follow-up. The regurgitation had progressed by at least 1 grade in 38 of the 82 patients (46.4%). Neo-aortic dilation was noted at the basal attachment of the leaflets, and at mid-sinusal level, which was out of proportion to somatic growth.Conclusions: At mid-term follow-up, significant neo-aortic valve regurgitation is present in 3.7%, and trivial to mild regurgitation in 81.4% of patients. The regurgitation progressed in almost half of the patients over time. We also noted progressive dilation of the neo-aortic root out of proportion to somatic growth.

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More in, better out? Successful valve-in-valve procedure of an iatrogenic ventricular septal defect following transcatheter aortic valve replacement: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab097 ◽

2021 ◽

Vol 5 (5) ◽

Author(s):

Klaus-Dieter Hönemann ◽

Steffen Hofmann ◽

Frank Ritter ◽

Gerold Mönnig

Keyword(s):

Aortic Valve ◽

Ventricular Septal Defect ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Septal Defect ◽

Left Ventricular ◽

Heart Team ◽

Transcatheter Aortic Valve ◽

Valve In Valve

Abstract Background A rare, but serious, complication following transcatheter aortic valve replacement (TAVR) is the occurrence of an iatrogenic ventricular septal defect (VSD). Case summary We describe a case of an 80-year-old female who was referred with severe aortic stenosis for TAVR. Following thorough evaluation, the heart team consensus was to proceed with implantation via a transapical approach of an ACURATE neo M 25 mm valve (Boston Scientific, Natick, MA, USA). The valve was deployed harnessing transoesophageal echocardiographic (TOE) guidance under rapid pacing with post-dilation. Directly afterwards a very high VSD close to the aortic annulus was detected. As the patient was haemodynamically stable, the procedure was ended. The next day another TOE revealed a shunt volume (left-to-right ventricle) between 50% and 60%. Because the defect was partly located between the stent struts of the ACURATE valve decision was made to fix this leakage with implantation of a further valve and we chose an EVOLUT Pro 29 mm (Medtronic Inc., Minneapolis, MN, USA). The valve-in-valve was implanted 2–3 mm below the lower edge of the first valve, more towards the left ventricular outflow tract (LVOT) with excellent result: VSD was reduced to a very small residual shunt without any hemodynamic relevance. Discussion We suggest that an iatrogenic VSD located near the annulus may be treated percutaneously in a bail-out situation with implantation of a second valve that should be implanted slightly more into the LVOT to cover the VSD.

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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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Arterial Switch Operation With Neoaortic Valve Replacement in a 13-Year Old Patient With Transposition of Great Arteries With Ventricular Septal Defect and Left Ventricular Outflow Tract Obstruction—A Case Report

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135118769320 ◽

2018 ◽

Vol 11 (4) ◽

pp. NP190-NP194

Author(s):

Kuntal Roy Chowdhuri ◽

Manoj Kumar Daga ◽

Subhendu Mandal ◽

Pravir Das ◽

Amanul Hoque ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Valve Replacement ◽

Septal Defect ◽

Left Ventricular Outflow Tract ◽

Arterial Switch Operation ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Transposition Of Great Arteries ◽

Switch Operation ◽

Left Ventricular Outflow

The surgical management of d-transposition of great arteries (d-TGAs) with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO) is ever evolving and still remains a challenge because of wide anatomic variability, age of presentation, surgical options available, and their variable long-term results in different series. We describe a patient with d-TGA, VSD, and LVOTO who presented to us at 13 years of age and underwent an arterial switch operation along with neoaortic valve replacement with a mechanical prosthesis. The postoperative course was uneventful, and at hospital discharge, the echocardiogram was satisfactory. We present the pros and cons of this hitherto undescribed treatment option.

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