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

Abstract

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.

Role of echocardiography in the assessment and management of adult congenital heart disease in pregnancy

“…Various surgical procedures have been proposed [72][73][74][75][76][77][78][79][80][81][82][83][84]. Pregnancy [74] can accelerate the systemic RV dysfunction that occurs in about 20% of pts with d-TGA after atrial switch procedure (Mustard/Senning operation) followed longitudinally (Fig.…”

“…Midterm results of the arterial switch procedure (Jatene operation) have been promising, however there have been reports of pulmonary stenosis [81], neo-aortic root dilatation and valve regurgitation [82], decreased coronary blood flow reserve, LV wall motion abnormalities, reversible myocardial perfusion defects, and depressed LV contractility [83]. The first early survivors of the Jatene operation are now reaching child-bearing age and the first patient undergoing a successful (live birth) pregnancy has been reported [84].…”

Decreased Incidence of Supravalvar Pulmonary Stenosis After Arterial Switch Operation

“…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. Reconstruction of the neopulmonic root therefore requires a pantaloon pericardial patch encompassing two-thirds of the anastomosis between the neopulmonic root and pulmonary artery.…”