Late re-interventions following arterial switch operations in transposition of the great arteries*Incidence and surgical treatment of postoperative pulmonary stenosis

Spiegelenberg, Stefan R.; Hutter, Paul A.; Wal, H. J. C. M. Van De; Hitchcock, J. F.; Meijboom, Erik J.; Harinck, E.; Sethia, B; Monro, James L.; Tark, Ji Yun; Métras, D

doi:10.1016/s1010-7940(05)80041-7

Cited by 31 publications

(21 citation statements)

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“…ASO is the procedure of choice for neonates with simple TGA with or without VSD, but the onset of supravalvular pulmonary stenosis, with incidence varying from 17 to 55% according to different criteria, was an important postoperative complication during long-term follow-up [8,9,10]. Several parameters, including surgical techniques, coronary artery patterns [12], age at operation and preoperative pulmonary stenosis were reported to be risk factors for the development of postoperative pulmonary stenosis [11, 12].…”

Section: Discussionmentioning

confidence: 99%

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Prediction of Early Pulmonary Artery Stenosis after Arterial Switch Operation: The Role of Intraoperative Transesophageal Echocardiography

Chen¹,

Tsai

Chang³

et al. 2007

Cardiology

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Objectives: To investigate prospectively the prediction of the neopulmonary stenosis (neo-PS) after arterial switch operation (ASO) for transposition of the great artery (TGA) with intraoperative transesophageal echocardiography (TEE). Methods: Infants with TGA undergoing the ASO were prospectively studied over 5 years. The neo-PS was defined when the peak flow velocity was over 3 m/s at the neo main pulmonary artery (neo-MPA) after ASO by TEE (TEEPS). Catheterization was performed if estimated peak neo-PS pressure gradient was over 40 mm Hg by transthoracic echocardiography. Balloon angioplasty was tried first and surgical reoperation was reserved for those with failed angioplasty. Results: In total 49 consecutive patients were enrolled into the cohort study. TEEPS was identified in 21 patients. For patients with TEEPS, freedom from reintervention was 28% at 1 year and 23% at 2 years. For patients without TEEPS, freedom from reintervention for PS was 92% at 1 year and 78% at 2 years. The time interval from ASO to reintervention was significantly shorter in patients with TEEPS than without TEEPS. Existence of TEEPS and non-Lecompte method were main risk factor for reintervention. Conclusion: The present study demonstrated that the application of intraoperative TEE for infants undergoing ASO is very helpful in predicting the development of early postoperative neo-PS.

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Section: Discussionmentioning

confidence: 99%

“…The incidence of neo-PS after ASO varied from 17 to 55%, depending on the different criteria in several reports [8,9,10,11]. Several factors including surgical techniques, age at operation, preoperative PA pressure and stenosis were suggested to be correlated with the development of postoperative neo-PS [11, 12].…”

Section: Introductionmentioning

confidence: 99%

Prediction of Early Pulmonary Artery Stenosis after Arterial Switch Operation: The Role of Intraoperative Transesophageal Echocardiography

Chen¹,

Tsai

Chang³

et al. 2007

Cardiology

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“…whenever the suture line is too close to the pulmonary valve, the stenosis is difficult to relieve with balloon angioplasty and frequently requires enlargement of the complete RV outflow tract with a transannular patch. In general, balloon dilatation combined with intravascular stent deployment is more effective in the management of branch PA narrowing but not in supravalvar neopulmonary artery stenosis 33,36 .…”

Section: Treatmentmentioning

confidence: 98%

“…PA stenosis is by far the most common sequela reported in adults after AsO, with an estimated prevalence ranging from 17% to 55% 12,32,33 . It is haemodinamically significant in approximately 10-25% of cases, irrespective of the type of repair.…”

Section: Rvot Complications Epidemiologymentioning

confidence: 99%

Arterial switch operation for transposition of great arteries: late results in adult patients

Scognamiglio

Li²

2015

ICFJ

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Complete transposition of the great arteries (TGA) accountsfor 5% to 7% of congenital cardiac anomalies, and representsthe second most common cyanotic heart defect. Successfulsurgery, allowing the majority of patients to survive toadulthood, can either involve a physiologic or anatomic“correction”. The former (i.e. atrial switch), introduced in1958 by Senning and later modified by Mustard, corrects thephysiologic abnormality of the TGA by creating an atrial baffleto direct the venous return to the contralateral atrioventricularvalve and ventricle. Although mid-term clinical resultsare excellent, this procedure leaves the RV supporting thesystemic circulation. Hence, complications such as progressiveRV dysfunction, ensuing tricuspid regurgitation, frequentarrhythmias, heart failure and early mortality may arise in thelong-term5.

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“…1 However, despite its improved outcomes over the mustard and atrial switch procedures, 1,2 postoperative supravalvar pulmonary stenosis (SVPS) is common. Supravalvar pulmonary stenosis occurs in 17% to 55% of patients [3][4][5][6] and is related to surgical technique, as well as age at operation. 7 Historically, the coronary arteries are removed from the neopulmonic root by excising the entire associated sinus of Valsalva.…”

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confidence: 99%

Decreased Incidence of Supravalvar Pulmonary Stenosis After Arterial Switch Operation

Swartz

Sena²,

Atallah-Yunes³

et al. 2012

Circulation

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Background-Supravalvar pulmonary stenosis (SVPS) is frequently observed after arterial switch. Traditionally the coronary arteries are removed from the neopulmonic root by excising the entire sinus of Valsalva. As a result, reconstruction of the neopulmonic root requires a pericardial patch encompassing two-thirds of the anastomosis between the neopulmonic root and pulmonary artery. We present a technique where the coronary arteries are removed as limited buttons of sinus tissue, leaving the transected edge of the neopulmonic root intact. We hypothesize that maintaining native arterial tissue in the anastomosis between the neopulmonic root and the pulmonary artery bifurcation reduces postoperative SVPS. Methods and Results-We performed a retrospective review of neonates with D-transposition of the great arteries undergoing arterial switch procedure from 1996 to 2009. Charts were reviewed, and clinical outcomes recorded for each patient. Most recent echocardiograms were evaluated for right ventricular outflow tract obstruction. A total of 120 patients received arterial switch using this technique. There was 99% survival and no injuries to the coronary arteries regardless of anatomy. Total follow-up was 564 patient-years. Mean follow-up at last clinical visit was 66Ϯ46 months. Evaluation of the most recent outpatient echocardiogram revealed an average peak instantaneous gradient across the neopulmonic root of 22.5Ϯ5 mm Hg. Only 7 (5%) patients required reintervention (balloon dilation, nϭ5; surgery, nϭ2). Conclusions-Our technique of removing the coronary arteries as limited buttons, and anastomosis of the pulmonary artery using only native arterial tissue provides excellent midterm results with minimal SVPS. (Circulation. 2012;126[suppl 1]:S118 -S122.)

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Late re-interventions following arterial switch operations in transposition of the great arteries*Incidence and surgical treatment of postoperative pulmonary stenosis

Cited by 31 publications

References 0 publications

Prediction of Early Pulmonary Artery Stenosis after Arterial Switch Operation: The Role of Intraoperative Transesophageal Echocardiography

Prediction of Early Pulmonary Artery Stenosis after Arterial Switch Operation: The Role of Intraoperative Transesophageal Echocardiography

Arterial switch operation for transposition of great arteries: late results in adult patients

Decreased Incidence of Supravalvar Pulmonary Stenosis After Arterial Switch Operation

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