Restoring the spiral flow of nature in transposed great arteries

Chiu, Ing‐Sh; Huang, Shu‐Chien; Chen, Yih‐Sharng; Chang, Chung-I; Lee, Meng-Luen; Chen, Shyh-Jye; Chen, Ming–Ren; Wu, Mei‐Hwan

doi:10.1016/j.ejcts.2009.12.032

Cited by 14 publications

(18 citation statements)

References 21 publications

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“…With CMR providing optimal surveillance of PA anatomy after the ASO, 4,42 measurements of bending can be reliably followed as patients age. Alternative surgical treatments, such as the spiral technique, 43 could possibly create a more favorable flow profile from the spiral configuration of pulmonary arteries 14 ; however, this technique has little mid-term and long-term outcome data.…”

Section: Commentmentioning

confidence: 99%

Abnormal Pulmonary Artery Bending Correlates With Increased Right Ventricular Afterload Following the Arterial Switch Operation

Loke

Capuano

Mandell

et al. 2019

World J Pediatr Congenit Heart Surg

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Purpose: In transposition of great arteries, increased right ventricular (RV) afterload is observed following arterial switch operation (ASO), which is not always related to pulmonary artery (PA) stenosis. We hypothesize that abnormal PA bending from the Lecompte maneuver may affect RV afterload in the absence of stenosis. Thus, we sought to identify novel measurements of three-dimensional cardiac magnetic resonance (CMR) images of the pulmonary arteries and compare with conventional measurements in their ability to predict RV afterload. Methods: Conventional measurements and novel measurements of the pulmonary arteries were performed using CMR data from 42 ASO patients and 13 age-matched controls. Novel measurements included bending angle, normalized radius of curvature ( Rc), and normalized weighted radius of curvature ( Rc- w). Right ventricular systolic pressures (as the surrogate for RV afterload) were measured by either recent echocardiogram or cardiac catheterization. Results: Conventional measurements of proximal PA size correlated with differential pulmonary blood flow ( r = 0.49, P = .001), but not with RV peak systolic pressures ( r = −0.26, P = .18). In ASO patients, Rc- w correlated with higher RV systolic pressures ( r = −0.57, P = .002). Larger neoaortic areas and rightward bending angles correlated with smaller right pulmonary artery Rc ( r = −0.48, P = .001; r = 0.41, P = .01, respectively). Finally, both pulmonary arteries had significantly smaller Rc compared to normal controls. Conclusions: Pulmonary arteries exhibit abnormal bends following ASO that correlate with increased RV afterload, independent of PA stenosis. Future work should focus on clinical and hemodynamic contributions of these shape parameters.

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Section: Commentmentioning

confidence: 99%

Abnormal Pulmonary Artery Bending Correlates With Increased Right Ventricular Afterload Following the Arterial Switch Operation

Loke

Capuano

Mandell

et al. 2019

World J Pediatr Congenit Heart Surg

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“…In patients with transposition, this spiral pattern is missing as part of the disease, 22 and hence the missing overall helicity in all of our studied patients could perhaps be explained by the missing looping. An alternative surgical arterial switch technique with restoring the spiral relationship of the great arteries, as proposed and presented by Chiu and colleagues, 24 , 25 might be useful to restore the overall helicity. This spiral flow has beneficial effects on cardiac work and on protecting the arterial wall from atherogenesis, as demonstrated in aortic segments of rabbits 26 .…”

Section: Discussionmentioning

confidence: 99%

Flow-sensitive four-dimensional velocity-encoded magnetic resonance imaging reveals abnormal blood flow patterns in the aorta and pulmonary trunk of patients with transposition

et al. 2013

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“…Last, utilization of the spiral anastomsosis has been favored due to its ability to restore the great vessels to their natural position; however, this has not been shown to significantly reduce the incidence of SVPS. 15 Recently, the importance of aortic insufficiency has been noted in patients after arterial switch. The incidence of aortic insufficiency within our patients is similar to what has been previously reported during an intermediate-term follow-up.…”

Section: Discussionmentioning

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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Restoring the spiral flow of nature in transposed great arteries

Cited by 14 publications

References 21 publications

Abnormal Pulmonary Artery Bending Correlates With Increased Right Ventricular Afterload Following the Arterial Switch Operation

Abnormal Pulmonary Artery Bending Correlates With Increased Right Ventricular Afterload Following the Arterial Switch Operation

Flow-sensitive four-dimensional velocity-encoded magnetic resonance imaging reveals abnormal blood flow patterns in the aorta and pulmonary trunk of patients with transposition

Decreased Incidence of Supravalvar Pulmonary Stenosis After Arterial Switch Operation

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