Outcome in adult patients after arterial switch operation for transposition of the great arteries

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

“…In the first series, before the Lecompte manoeuvre was routinely performed, RV to PA connection was maintained by a conduit. these patients showed high prevalence of significant RVOt obstruction since childhood and, as a consequence, were at highest risk for cardiac reintervention as adults 9,15,34 . After the introduction of the Lecompte manoeuvre and despite evolution of PA surgical reconstruction of the PA, RVOt stenosis continued to be the most frequent long-term complication, with the obstruction mostly located in the main trunk or proximal branches, although valvular and subvalvular stenoses, as well as combined obstructions at various levels, are also described.…”

“…now reaching the adulthood and recent studies are beginning to define the characteristics and the outcome of this emerging adult cohort 9,[15][16][17][18][19][20] . (Table 1) generally, the early adults with AsO continue to do well with excellent long-term survival after hospital discharge.…”

“…(Table 1) generally, the early adults with AsO continue to do well with excellent long-term survival after hospital discharge. In a cohort of 145 patients with a median follow-up of 9.0 years, 3 patients died, achieving a corresponding mortality rate of 2.4/1000 adult patients-years 15 . these results were confirmed in a recent study of 400 patients, where later deaths occurred in 6 of 374 (1.6%) perioperative survivors, yielding a survival rate of 99.2% at 10 years and 96.7% at 25 years 16 .…”

“…In a retrospective analysis by Kempny et al in adult AsO patients, among the echocardiographic parameters only mitral anular plane systolic excursion (MAPse) was found to correlate with exercise tolerance parameters and longitudinal LV function was found to be reduced in a higher proportion of patients compared to LV-eF (15.0% vs. 9.6%). It has been argued that minor changes in myocardial perfusion may affect the subendocardial myocardial layer, whose fibers are mainly longitudinally arranged, and, thus may explain longitudinal LV dysfunction 15 . this was also confirmed by a speckle-tracking echocardiography study showing a normal eF but a significant, even though slight, reduction of global LV longitudinal strain in AsO patients when compared to healthy controls 29.…”

Non-invasive imaging in congenital heart disease

“…(25) CMR can accurately assess the pulmonary artery branches and also the relative pulmonary blood flow to each lung. CMR is also the technique of choice for the long-term follow-up of those who underwent coarctation of the aorta repair.…”