Hemolysis due to branch pulmonary stenosis after the arterial switch procedure

Schroeder, James K.; Albert, James D.; Clarke, David R.; Schaffer, Michael S.; Wolfe, Robert R.; Hays, Taru

doi:10.1016/0003-4975(91)90878-t

Cited by 12 publications

(5 citation statements)

References 9 publications

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“…Branch PA stenosis (usually left) was more common in cases of more side-by-side great arteries when the Lecompte maneuver was used with inadequate dissection of the branch PA [18]. Hemolysis or lethal sepsis from LPA stenosis has been reported [19, 20]. …”

Section: Discussionmentioning

confidence: 99%

Morphologic Substrates for First-Branch Pulmonary Arterial Hypoplasia in Transposition of the Great Arteries

Chen

Wu²,

Chiu³

et al. 2007

Cardiology

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Background: Distal right-sided outflow obstruction remains a problem after arterial switch operation. We studied the anatomical features of the pulmonary trunk (PT) and its branches that are susceptible to right and left pulmonary arterial (RPA and LPA) hypoplasia in transposition of the great arteries (TGA). Methods: One hundred and one angiograms of TGA performed between 1981 and 1996 were viewed, and Polaroid photos were taken at end-systole. The diameters of RPA, LPA, PT, duct, ascending aorta, and angles between PA and PT were measured, and the ductal flow direction was recorded. Results: Forty-eight cases (47.5%) had a PA/PT diameter ratio (both PAs had same size) below 0.49. A smaller PA/PT was significantly related to posterior inclination of the proximal PT [narrower right (r = 0.50, p < 0.00001) and left (r = 0.48, p < 0.00001) PA-PT angle in lateral view] and a larger duct (r = 0.37, p < 0.0001). Eighteen patients had a follow-up angiogram after a mean period of 8.5 months. Those with a closed duct had evident PA growth (n = 12, 0.51 ± 0.09 to 0.74 ± 0.17, p < 0.0001), but four patients with an attenuated duct had no significant change (0.58 ± 0.06 to 0.68 ± 0.08, p = NS), and one with a persistent large duct had even regression of PA/PT (0.36–0.19). The direction of ductal flow was toward the aorta during early systole on cineangiogram. Conclusions: First-branch PA hypoplasia, which is frequently seen in TGA, was related to the right-to-left shunt through a duct resulting in hemodynamic starvation, and to posterior inclination of the proximal PT in this setting. Natural regression of the duct facilitated PA growth.

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Section: Discussionmentioning

confidence: 99%

Morphologic Substrates for First-Branch Pulmonary Arterial Hypoplasia in Transposition of the Great Arteries

Chen

Wu²,

Chiu³

et al. 2007

Cardiology

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“…In congenital heart surgery, the majority of reported cases have involved foreign materials. In the absence of prosthetic material, five cases were described: one caused by coarctation, which resolved after repair [5], one resulting from pulmonary branch stenosis after an arterial switch operation [6] and three occurring after AVSD repair [7][8][9]. In these cases, no prosthetic material was used and the sources of haemolysis were the residual defects, resulting in regurgitation.…”

Section: Discussionmentioning

confidence: 98%

Repeat mitral valve repair for haemolysis in children

Weill

Peyre

Vergnat

et al. 2015

Archives of Cardiovascular Diseases

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“…Контролировать возросшую объемную нагрузку ЛЖ, осуществляя его ретренинг с помощью экстракорпоральной мембранной оксигенации, можно и после корригирующей операции, как полагают некоторые авторы [11]. К сожалению, экстракорпоральная мембранная оксигенация -это технически сложная процедура, пролонгирующая интенсивную терапию и общее время нахождения пациента в клинике и во многих случаях сопровождающаяся серьезными осложнениями и летальностью [16,18]. В представленной серии пациентов с «простой» ТМА, которым артериальное переключение в периоде новорожденности не могло быть выполнено в связи с сопутствующими экстракардиальными перинатальными осложнениями, мы выполнили первый этап анатомической коррекции порока.…”

Section: Discussionunclassified

“…Проблема формирования стеноза легочной артерии в зоне анастомоза и устьев ветвей легочной артерии после артериального переключения подробно освещена в различных публикациях [17,18]. Однако в данной серии обследованных пациентов не обнаружено гемодинамически значимых резидуальных стенозов легочного ствола и легочных артерий ни в основной, ни в контрольной группе.…”

Section: Discussionunclassified

Two-stage anatomical repair of “simple” transposition of great arteries in neonates with extracardiac perinatal complications

Корноухов¹,

Il'in²,

Valitova³

et al. 2017

PKiK

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Aim. This study was designed to analyse the results of two-stage arterial switch operation (ASO) of “simple” transposition of great arteries in patients with infection, neurological problems or necrotizing enterocolitis, which preclude neonatal surgery. Methods. Transthoracic echocardiography data and outcomes of surgery were investigated in 19 patients (study group; #1) after two-stage ASO and 67 patients (control group; #2) after a single-stage ASO. Age of patients at the first stage was 27 (8–55) days and at the second stage 172 (92–256) days. Patients in group 2 were 7 (2–53) days old. All of them were followed up for 21 (4–49) months (group 1) and 40 (7–79) months (group 2) after arterial switch operation. Results. There was no operative mortality at both stages in group 1. The duration of ventilation, length of intensive care unit and hospital stay after surgery were considerably lower in group 1. Actuarial sur-vival and freedom from reoperation at 4 years in group 1 accounted for 100%, while in the con-trol group those indicators at 6 years ran to 98.5% and 94%, respectively. The only difference detected by echocardiography was the aortic valve hinge points Z-score (3.9±1.44 vs 3.1±1.27; p=0.025) and sinuses of Valsalva (3.8±1.41 vs 2.8±1.19; p=0.03), which were higher in the 1st group. There was no aortic regurgitation >1 grade in both groups. Conclusion. Two-stage repair of “simple” transposition of great arteries, when it’s necessary to delay arterial switch operation on the clinical grounds, can be performed with excellent clinical outcomes. The tendency of group 1 patients to have a larger neo-aortic root does not appear to bear any clinical significance in mid-term follow-up.Received 21 December 2016. Accepted 8 May 2017.Funding: The study had no sponsorship. Conflict of interest: The authors declare no conflict of interest. Author contributions Study concept and design: Kornoukhov O.Yu., Ilyin V.N. Data collection and analysis: Kornoukhov O.Yu., Valitova A.A., Kryukov V.A. Drafting the article: Kornoukhov O.Yu. Critical revision of the article: Kornoukhov O.Yu., Ilyin V.N. Final approval of the version to be published: Kornoukhov: O.Yu., Ilyin V.N.

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Hemolysis due to branch pulmonary stenosis after the arterial switch procedure

Cited by 12 publications

References 9 publications

Morphologic Substrates for First-Branch Pulmonary Arterial Hypoplasia in Transposition of the Great Arteries

Morphologic Substrates for First-Branch Pulmonary Arterial Hypoplasia in Transposition of the Great Arteries

Repeat mitral valve repair for haemolysis in children

Two-stage anatomical repair of “simple” transposition of great arteries in neonates with extracardiac perinatal complications

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