Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum

Sarris, George E.; Balmer, Christian; Bonou, Pipina; Comas, Juan V.; Cruz, Eduardo M. da; Chiara, Luca Di; Donato, Roberto M. Di; Fragata, José; Jokinen, Tuula Eero; Kirvassilis, George; Lytrivi, Irene D.; Milojevic, Milan; Sharland, Gurleen; Siepe, Matthias; Stein, Joerg I.; Büchel, Emanuela Valsangiacomo; Vouhé, Pascal

doi:10.1093/ejcts/ezw360

Cited by 78 publications

(76 citation statements)

References 390 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…12 Today, the ASO is currently the procedure of choice for TGA, especially when performed in the first month of life. 13 However, in many parts of the world, a significant number of the newborn patients with TGA cannot be diagnosed at the early period and alternative strategies are deemed mandatory for treatment of these infants. 14 In cases where the LV is exposed to systemic pressures from birth such as in cases with unrestrictive VSD, pulmonary stenosis, congestive heart failure or pulmonary hypertension, it sustains the systemic pressures after the arterial switch procedure, which is a similar fact following double switch procedures in patients with cc-TGA, as well.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, attempts to palliate cyanotic newborns with TGA even began with Blalock-Hanlon septectomy which was performed in 1948, before the era of open-heart surgery 11. Today, the ASO is currently the procedure of choice for TGA, especially when performed in the first month of life 13. Afterward, the untoward effects of atrial switch were sought to be addressed by ASO which aimed to anatomically correct TGA 12.…”

mentioning

confidence: 99%

See 1 more Smart Citation

A better approach for left ventricular training in transposition of the great arteries and intact interventricular septum: Bidirectional cavopulmonary anastomosis and pulmonary artery banding

Bilal

Özyüksel

Avsar

et al. 2019

Congenital Heart Disease

View full text Add to dashboard Cite

Objective: Management of the patients with transposition of the great arteries and intact ventricular septum may be challenging beyond the newborn period. Herein, we would like to present our alternative strategy for training the left ventricle in these patients. Methods:Six patients with transposition of the great arteries and intact ventricular septum were evaluated in our clinic. Two of them were palliated with Glenn procedure and pulmonary banding as a definitive treatment strategy at other centers. Four patients were operated on and a bidirectional cavopulmonary anastomosis in combination with pulmonary artery banding was performed (stage-1: palliation and ventricular training) in our center. In four out of these six patients, arterial switch operation was performed with takedown and direct re-anastomosis of the superior vena cava to right atrium after an interstage period of 21-30 months (stage-2: anatomical repair).Results: Any mortality was not encountered. The left ventricular mass indices increased from 18-32 to 44-74 g/m 2 in patients undergoing the anatomical repair. All of the patients were uneventfully discharged following the second stage. The mean follow-up period was 20 months (9-32 months) following stage 2. All of the patients are doing well with trivial neoaortic regurgitation and normal biventricular function. Conclusions:Bidirectional cavopulmonary anastomosis with pulmonary artery banding may be a promising left ventricle training approach in ventriculoarterial discordance when compared to the traditional pulmonary artery banding with concomitant systemic-to-pulmonary artery shunt procedures which still carry a significant interstage morbidity and mortality. K E Y W O R D Sarterial switch operation, bidirectional Glenn procedure, intact ventricular septum, modified Blalock-Taussig shunt, transposition of the great arteries

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

A better approach for left ventricular training in transposition of the great arteries and intact interventricular septum: Bidirectional cavopulmonary anastomosis and pulmonary artery banding

Bilal

Özyüksel

Avsar

et al. 2019

Congenital Heart Disease

View full text Add to dashboard Cite

show abstract

“…6,8,9 We have shown that the size of the PV annulus at 26 to 30 weeks hypertension. 35 Hourihan et al also observed that the NAoR and PV annulus are already larger than in normal infants before the ASO. 8 An increased risk of NAoR dilation in TBA and TGA with VSD has previously been recognized, 13,16,18 highlighting the role of a significant VSD in the pathophysiology of NAoR dilatation.…”

Section: Neo-aortic Rootmentioning

confidence: 91%

Transposition of the great arteries: Fetal pulmonary valve growth and postoperative neo‐aortic root dilatation

et al. 2019

View full text Add to dashboard Cite

ObjectivesDocumentation of semilunar valve growth in fetal transposition of the great arteries (TGA) and the relationship between neo‐aortic root (NAoR) dilatation, a cause for postoperative reinterventions after the arterial switch operation (ASO), and pulmonary valve (PV) annulus dimensions prenatally.MethodsThis retrospective multicenter observational study included TGA fetuses suitable for ASO. Semilunar valve annuli pre‐ASO and NAoR diameters (post‐ASO) were measured. Trends in annulus diameters were analyzed using a linear mixed‐effects model and compared with normal values. Prenatal semilunar valve Z‐scores were correlated with NAoR diameters post‐ASO.ResultsWe included 137 TGA fetuses (35.8% with significant ventricular septal defects [VSDs]). One hundred twenty‐one underwent ASO. Fetal TGA‐PV diameters were significantly larger than control aortic valve (AoV) and PV annuli from 23 and 27 weeks, respectively, especially when a VSD was present. Fetal TGA‐AoV annuli were significantly larger than control AoV and PV annuli from 26 and 30 weeks, respectively. Z‐scores of fetal TGA‐PV and NAoR diameter at last follow‐up correlated significantly (P < .001 at 26‐30 wk).ConclusionFetal TGA semilunar valve annuli are larger than control annuli, especially when there is a significant VSD. Factors besides postoperative hemodynamics, including fetal anatomy, PV Z‐score, prenatal flow, connective tissue properties, and genetics, may influence the risk for late reintervention in these fetuses.

show abstract

“…Though coronary artery patterns precluding safe coronary transfer are exceedingly rare, a coronary event following transfer is a devastating complication with 57% mortality . If a child is not a candidate for coronary transfer in conjunction with arterial switch and has adequate semilunar valves, the most commonly used procedure is an atrial switch . The Damus‐Kaye‐Stansel (DKS) anastomosis with right ventricle (RV) to pulmonary artery (PA) conduit placement was originally described for the repair of D‐TGA, but it is infrequently utilized for this purpose in contemporary practice.…”

Section: Introductionmentioning

confidence: 99%

“…2 If a child is not a candidate for coronary transfer in conjunction with arterial switch and has adequate semilunar valves, the most commonly used procedure is an atrial switch. 3 The Damus-Kaye-Stansel (DKS) anastomosis with right ventricle (RV) to pulmonary artery (PA) conduit placement was originally described for the repair of D-TGA, but it is infrequently utilized for this purpose in contemporary practice. We favor the DKS repair over atrial switch as it commits the left ventricle to the systemic circulation, and present a series of four children with complex D-TGA who underwent DKS repair and RV-PA conduit placement.…”

Section: Introductionmentioning

confidence: 99%

Damus-Kaye-Stansel procedure avoids coronary obstruction in complex D-transposition

2018

View full text Add to dashboard Cite

Although all coronary anatomy in D‐transposition of the great arteries may be “switchable,” there are reports in the literature of early and late coronary obstruction following the arterial switch operation. The Damus‐Kaye‐Stansel procedure does not risk injury to the coronary arteries, and unlike the atrial switch, commits the left ventricle to the systemic circulation. We present a series of four neonates over 22 years with D‐transposition of the great arteries and a concomitant coronary artery anomaly precluding arterial switch that were repaired using a Damus‐Kaye‐Stansel procedure and right ventricle to pulmonary artery conduit.

show abstract

Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum

Cited by 78 publications

References 390 publications

A better approach for left ventricular training in transposition of the great arteries and intact interventricular septum: Bidirectional cavopulmonary anastomosis and pulmonary artery banding

A better approach for left ventricular training in transposition of the great arteries and intact interventricular septum: Bidirectional cavopulmonary anastomosis and pulmonary artery banding

Transposition of the great arteries: Fetal pulmonary valve growth and postoperative neo‐aortic root dilatation

Damus-Kaye-Stansel procedure avoids coronary obstruction in complex D-transposition

Contact Info

Product

Resources

About