Comparison of cardiac function in surgically corrected and congenitally corrected transposition of the great arteries

Peterson, Richard J.; Franch, Robert H.; Fajman, William A.; Jones, Robert H.

doi:10.1016/s0022-5223(19)35263-8

Cited by 70 publications

(21 citation statements)

References 31 publications

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“…The pulmonary stenosis was bypassed by LV to main pulmonary artery conduit and thus morphologic RV always remained as the systemic ventricle [8]. Suboptimal function of the systemic RV either at rest or on exercise, and its early failure has been well established in these lesions [19,20].…”

Section: Discussionmentioning

confidence: 99%

Innovative mirror image transatrial techniques for biventricular repair in inverted dextrocardia

Salve¹,

Jain²,

Nimbalkar³

et al. 2018

cardiovascular-surgery

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Background: Correction of hearts with situs inversus dextrocardia represent technical challenges due to mirror image anatomy and altered conduction pathway. Ventriculotomy has been the traditional approach for biventricular repair. We report our experience of trans-atrial approach in these patients employing an easily reproducible preoperative delineation of the anatomy. In addition we also discuss our way of surgical execution for these complex subsets. Methods and Findings: 15 patients (M:F=7:8) with situs inversus dextrocardia with diverse congenital cardiac anomalies underwent biventricular repair through our trans-atrial approach from left side of patient with detailed pre-operative evaluation of the anomalies. Orientation of intra-cardiac anatomy was obtained pre-operatively by rendering standard illustrations in reversed and inverted way. Median age and weight were 12 months (4.5 months-31 years) and 5.8 kg (3.4-59 kg) respectively. The surgical spectrum included closure of ventricular septal defects (n=6), repair of double outlet right ventricle (n=3), repair of tetralogy of Fallot (n=5) and double switch operation for congenitally corrected transposition of great arteries, routable ventricular septal defect and pulmonary stenosis. Tricuspid valve leaflet detachment was performed frequently to aid the repair (n=7). Mean hospital stay was 12.4 ± 2.6 days with no hospital mortality. On follow-up, all patients remained in sinus rhythm and in New York Heart Association class I. One patient had a small residual ventricular septal defect with insignificant shunt. Another patient with tetralogy of Fallot correction underwent right pulmonary artery balloon plasty. Patient with double switch operation needed readmission for supraventricular tachycardia and medical management. Another patient of tetralogy of Fallot redeveloped infundibular gradient, awaiting intervention. Conclusions: Trans-atrial biventricular repair is feasible and reproducible in these subsets. The inverted illustrations facilitate in enabling successful repairs while avoiding heart blocks and ventriculotomy. Short-term results are satisfactory.

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Section: Discussionmentioning

confidence: 99%

Innovative mirror image transatrial techniques for biventricular repair in inverted dextrocardia

Salve¹,

Jain²,

Nimbalkar³

et al. 2018

cardiovascular-surgery

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“…The use of conduits should be avoided whenever possible. Peterson et al 25 showed that even in patients with no associated anomalies, therefore not in need of surgery, the venous-ventricle function is abnormal during exercise. This function is similar to that seen in patients with CTGV, who undergo an intra-atrial baffle operation (Mustard or Senning).…”

Section: Discussionmentioning

confidence: 99%

Right Transatrial Approach to Relieve Pulmonary Stenosis in Patients with Corrected Transposition of the Great Vessels: A New Operation Without Use of an Extracardiac Conduit

Molina

Wang

Stillman

2010

Journal of Cardiac Surgery

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Background: A new operation to relieve pulmonary obstruction is proposed for patients with corrected transposition of the great vessels and pulmonary stenosis (PS). A right transatrial approach involves excising or detaching the right‐sided atrioventricular valve (AV). Next, the pulmonary outflow tract is opened wide with an incision extending from the right‐sided ventricle upward across the AV valve annulus. This incision extends into the main trunk of the pulmonary artery located behind the right atrium. A patch, with or without implantation of a pulmonary valve prosthesis, widens the outflow tract, thus avoiding use of an extracardiac conduit. Method: We describe this operation performed in a 51‐year‐old man who had previously undergone correction with an extracardiac conduit that had become obstructed. The patient had severe right‐sided AV valve insufficiency and complete heart block with a functioning transvenous pacemaker. We replaced the right‐sided AV valve and positioned the permanent pacemaker lead outside of the prosthetic skirt. The PS was corrected as described above and a pulmonary prosthetic valve implanted. Use of an extracardiac conduit was avoided altogether. Conclusion: This technique may be applicable even without excising the right‐sided AV valve. The clinical result for our patient is still optimal 4 years after surgery.

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“…its value in the diagnosis of right ventricular systolic dysfunction. 15,16 Cineangiography has also been used. Thus, Graham and colleagues 17 studied 19 patients using cineangiography, and found that the right ventricular ejection fraction was abnormal in only 15% of patients less than 10 years of age.…”

Section: Discussionmentioning

confidence: 99%

Right ventricular function and ventricular perfusion defects in adults with congenitally corrected transposition: correlation of echocardiography and nuclear medicine

et al. 2004

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We undertook our study in order to evaluate right ventricular function and perfusion by conventional and contrast echocardiography in adults with congenitally corrected transposition who had not undergone cardiac surgery, comparing the echocardiographic findings with those obtained using equilibrium radionuclide ventriculography and gated single-photon emission computed tomography with Technetiumc-99 m sestamibi. We discovered severe tricuspid regurgitation in 8 patients (61%). Right ventricular ejection fraction, as calculated by nuclear medicine, had a correlation of 0.67 (p = 0.059) with area fractional shortening and 0.84 (p = 0.01) with ejection fraction calculated by the method depending on descent of the tricuspid ring. All patients with severe tricuspid regurgitation also had right ventricular dysfunction. Of these 8 patients, 7 had persistent perfusion defects, while 6 also had ischemic perfusion defects. Echo contrast had a high sensitivity, at 91%, and also specificity and positive predictive value, both at 100%, for persistent defects, and a negative predictive value of 66% compared to methods depending on nuclear medicine. The sensitivity of contrast echocardiography for detection of ischemic defects was 66%, the specificity 100%, the positive predictive value 100%, and the negative predictive value 77% compared to the methods involving nuclear medicine. The method depending on descent of the tricuspid ring had the highest correlation with equilibrium radionuclide ventriculography in evaluation of right ventricular function in patients with congenitally corrected transposition. We conclude that contrast echocardiography is extremely valuable when assessing right ventricular myocardial perfusion, having high sensitivity and specificity for detecting persistent defects, although sensitivity was less for detection of ischemic defects than that of gated single-photon emission computed tomography with Technetium-99 m Sestamibi. Persistent and ischemic perfusion defects, together with chronic volume overload from tricuspid regurgitation, are the determining factors of right ventricular dysfunction.

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Comparison of cardiac function in surgically corrected and congenitally corrected transposition of the great arteries

Cited by 70 publications

References 31 publications

Innovative mirror image transatrial techniques for biventricular repair in inverted dextrocardia

Innovative mirror image transatrial techniques for biventricular repair in inverted dextrocardia

Right Transatrial Approach to Relieve Pulmonary Stenosis in Patients with Corrected Transposition of the Great Vessels: A New Operation Without Use of an Extracardiac Conduit

Right ventricular function and ventricular perfusion defects in adults with congenitally corrected transposition: correlation of echocardiography and nuclear medicine

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