Rapid two-stage arterial switch operation. Evaluation of left ventricular systolic mechanics late after an acute pressure overload stimulus in infancy.

Boutin, Christine; Wernovsky, Gil; Sanders, Stephen P.; Jonas, Richard A.; Castañeda, Aldo R.; Colan, Steven D.

doi:10.1161/01.cir.90.3.1294

Cited by 66 publications

(44 citation statements)

References 49 publications

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“…In the clinical experience of the Boston group, Boutin et al [20] associated late left ventricular dysfunction to an extreme acute overload in patients submitted to Jatene's operation after LV rapid training. This dysfunction was inversely proportional to a quicker hypertrophy after PT banding.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, the physiopathology involved in this procedure is the same as what occurs in LV rapid training, as pulmonary banding or systemic pressure will cause the same LV hypertrophic stimulus. LV dysfunction can occur over the long-term, probably related to the degree of abrupt systolic stress imposed on the ventricle during its retraining.In the clinical experience of the Boston group, Boutin et al [20] associated late left ventricular dysfunction to an extreme acute overload in patients submitted to Jatene's operation after LV rapid training. This dysfunction was inversely proportional to a quicker hypertrophy after PT banding.…”

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confidence: 99%

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<![CDATA[Adjustable pulmonary trunk banding: comparison of two methods of acute subpulmonary ventricle hypertrophy]]>

Assad¹,

Rodriguez²,

Abduch³

et al. 2006

Braz. j. cardiovasc. surg.

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Bandagem ajustável do tronco pulmonar: comparação de dois métodos de hipertrofia aguda do ventrículo subpulmonarAdjustable pulmonary trunk banding: comparison of two methods of acute subpulmonary ventricle hypertrophy Abstract Objective: This study compares ventricular hypertrophy induced by continuous versus intermittent systolic overload of the pulmonary ventricle (RV) of young goats.Methods: Three groups of seven goats were used (control, continuous, and intermittent). Systolic overload was maintained for 96 hours in the continuous group, while the intermittent group suffered four 12-hour periods of systolic overload, alternating with 12-hour resting periods. Echocardiographic and hemodynamic evaluations were performed every day. The animals were then killed for myocardial water content and weight evaluation.Results: Both study groups achieved significant increases in RV mass (p<0.05). However, significant increases of the septum mass were observed only in the Intermittent Group (p<0.05). A greater increase in the RV wall thickness was observed in the Intermittent Group (p<0.05). There was a significant difference in RV diastolic volume between the two groups (p= 0.01), with a greater RV dilation in the Continuous Group after 24 hours of continuous overload (p< 419ASSAD, RS ET AL -Adjustable pulmonary trunk banding: comparison of two methods of acute subpulmonary ventricle hypertrophy Braz J Cardiovasc Surg 2006; 21(4): 418-428 INTRODUCTIONThe concept of rapid preparation of the left ventricular (LV) was introduced by the group from Boston in 1989 to treat transposition of the great arteries (TGA) after the neonatal period. Retraining of the subpulmonary ventricle was obtained in a mean time of nine days and after this Jatene's operation was performed [1]. These authors achieved good preliminary results, however, they were not reproduced in other centers due to high morbimortality. One of the greatest limitations of this technical approach is related to the lack of adjustability of the pulmonary trunk (PT) banding. The degree of PT banding may be inadequate or imprecise and can cause an important acute systolic overload of the LV [2,3].Heart hypertrophy is the main adaptive response of a heart submitted to physiological or pathological overload. It is interesting to note that the acquisition of LV mass during physical conditioning of athletes who practice swimming for example, reaches a peak in about only one week of training. Then the LV mass remains relatively constant [4] In an attempt to improve the rapid hypertrophic process without causing injury to the myocardium of the subpulmonary ventricle, we tried to find an analogy between the physiological hypertrophic processes in static-type exercises and intermittent PT banding, where periods of systolic overload are alternated with periods of subpulmonary ventricle relaxation.We formed a hypothesis that the subpulmonary ventricle, submitted to the gradual and progressive systolic overload alternated with periods of relaxation, could cause a more benefici...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

<![CDATA[Adjustable pulmonary trunk banding: comparison of two methods of acute subpulmonary ventricle hypertrophy]]>

Assad¹,

Rodriguez²,

Abduch³

et al. 2006

Braz. j. cardiovasc. surg.

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“…The latter imposes an added early risk, 11 which needs to be balanced against the relatively low operative mortality of the Senning/Mustard operation. Late follow-up of the 2-stage approach has revealed impaired LV systolic performance, 12 and an increased incidence of neoaortic regurgitation 13 and right ventricular outflow tract obstruction 14 compared with the primary arterial switch. The increased use of resources also makes the 2-stage approach less appealing in many parts of the world where economic constraints are paramount (K. S. Iyer, MCh, unpublished data, 2001).…”

Section: Discussionmentioning

confidence: 99%

Extending the Boundaries of the Primary Arterial Switch Operation in Patients With Transposition of the Great Arteries and Intact Ventricular Septum

et al. 2004

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Background-We have previously suggested that the primary arterial switch operation is a feasible strategy for patients with transposition of the great arteries and intact ventricular septum (TGA-IVS) up to age 2 months. This study reports our current results with this approach and examines whether this policy could be extended beyond age 2 months. Methods and Results-380 patients who underwent arterial switch for TGA-IVS were reviewed. 275 patients were younger than 3 weeks at the time of surgery (early switch group); 105 patients were 3 weeks or older (range, 21 to 185 days) (late switch group). There was no difference in outcome in terms of in-hospital mortality (5.5% versus 3.8%) or need for mechanical circulatory support (3.6% versus 5.7%) between early and late switch groups. However, duration of postoperative ventilation (4.9 versus 7.1 days, Pϭ0.012) and length of postoperative stay (12.5 versus 18.9 days, PϽ0.001) were significantly prolonged in the late switch group. Primary left ventricular failure resulting in death occurred in 2 patients in the late switch group, with no deaths in 9 patients aged 2 to 6 months. Conclusions-This experience confirms that in TGA-IVS, the left ventricle maintains the potential for systemic work well beyond the first month of life. Consequently, neonates at high risk or late referrals can benefit from delayed arterial switch, even beyond age 2 months. However, the need for mechanical support in some of the older patients may limit the widespread adoption of such a strategy.

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“…[6] introduced a concept of rapid LV preparation by banding it to the pulmonary trunk for TGA correction in two stages, showing appropriate hypertrophy of this chamber in a mean period of nine days. However, the long-term evolution also showed ventricular dysfunction and dilatation in approximately 25% of the evaluated patients (aspects that were not observed in patients who were operated early without need for previous ventricular preparation) [7]. Other studies also showed that acute pressure overload can lead to cellular necrosis focus in the hypertrophied myocardium and consequently late ventricular dysfunction [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Bandagem reversível do tronco pulmonar IV: análise da hipertrofia aguda do ventrículo direito em modelo experimental de sobrecarga intermitente

Valente¹,

Assad²,

Abduch³

et al. 2008

Rev Bras Cir Cardiovasc

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Rapid two-stage arterial switch operation. Evaluation of left ventricular systolic mechanics late after an acute pressure overload stimulus in infancy.

Abstract: Background Banding of the pulmonary artery to induce left ventricular (LV) hypertrophy followed by arterial switch operation (ASO) within 2 weeks has been performed when a primary ASO was considered high risk because of inadequate LV hypertrophy.

Cited by 66 publications

References 49 publications

<![CDATA[<B>Adjustable pulmonary trunk banding</B>: <B>comparison of two methods of acute subpulmonary ventricle hypertrophy</B>]]>

<![CDATA[<B>Adjustable pulmonary trunk banding</B>: <B>comparison of two methods of acute subpulmonary ventricle hypertrophy</B>]]>

Extending the Boundaries of the Primary Arterial Switch Operation in Patients With Transposition of the Great Arteries and Intact Ventricular Septum

Bandagem reversível do tronco pulmonar IV: análise da hipertrofia aguda do ventrículo direito em modelo experimental de sobrecarga intermitente

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