The morphologic left ventricle that requires training by means of pulmonary artery banding before the double-switch procedure for congenitally corrected transposition of the great arteries is at risk of late dysfunction

Quinn, David W.; McGuirk, Simon; Metha, Chetan; Nightingale, Peter; Giovanni, Joseph V. De; Dhillon, Rami; Miller, Paul A.; Stümper, Oliver; Wright, John; Barron, David J.; Brawn, William J.

doi:10.1016/j.jtcvs.2008.02.017

Cited by 93 publications

(52 citation statements)

References 31 publications

(38 reference statements)

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“…The incidence of late LV dysfunction is up to 20% in midterm follow-up, with a constant need for heart transplant. The negative impact of complete heart block, progressive aortic regurgitation, the need for retraining the LV, especially in older patients, and intraventricular tunnel obstruction, on the long-term function of the LV, are well documented [5,6,15]. Our data demonstrate the preservation of normal left ventricular function after correction, even in patients who required LV retraining.…”

Section: Discussionsupporting

confidence: 55%

“…A ratio of leftto-right ventricular systolic pressure of 0.8, in the presence of a well-preserved LV function, with the indexed LV mass to LV volume ratio >1.5, is considered to be adequate for anatomical correction [13]. Quinn et al [15] demonstrated that up to 50% of patients who underwent LV training before anatomic repair had moderate-to-severe LV dysfunction at intermediate follow-up, compared with a prevalence of 20% in patients who did not require training. In our series, four patients underwent PAB for retraining the LV.…”

Section: Issues Related To Asomentioning

confidence: 99%

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Functional outcome of anatomic correction of corrected transposition of the great arteries☆

Hraška

Mattes

Haun

et al. 2011

European Journal of Cardio-Thoracic Surgery

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Objective: Anatomic correction of corrected transposition of the great arteries, utilizing the morphologic left ventricle as a systemic pumping chamber, is considered the preferred method. The purpose of the study was to analyze the intermediate functional outcome following anatomical correction. Methods: Between 1997 and 6/2010, 23 patients with corrected transposition of the great arteries and associated lesions underwent anatomical correction. Seventeen (74%) and six patients (26%) had situs solitus {S,L,L} and situs invs {I,D,D}, respectively. Fifteen patients (65%) had undergone 18 palliations before the corrective operation. The median age at palliation was 0.23 years, with a range of 0.016-8.4 years. A corrective, modified Senning-arterial switch procedure was performed in nine patients, 13 patients underwent a modified Senning-Rastelli procedure, and in one patient a combination of modified Senning and aortic translocation (Bex/Nikaidoh) was used. The median age at the corrective operation was 2 years (from 0.3 to 15.7 years). Results: There was no mortality or heart transplant within the mean follow-up of 3.4 years. Freedom from reintervention was 77% at 5 years. There were no signs of obstruction of the systemic and pulmonary venous tunnels. The function of both ventricles was normal in all patients, even in the four patients who required retraining of the left ventricle. Mild aortic regurgitation was noticed in three patients. Preoperatively detected significant tricuspid regurgitation either disappeared or became trivial after the operation in all the six patients. All patients except two are in sinus rhythm; one patient is pacemaker-dependent preoperatively and one is pacemaker-dependent postoperatively. There were no clinically apparent neurological problems. All patients, but one, are in the New York Heart Association (NYHA) class I. Conclusions: Anatomic correction of corrected transposition of the great arteries can be performed in selected patients without mortality and with acceptable morbidity. The mid-term functional outcome is excellent, resulting in normal ventricular function, even in retrained left ventricles, and minimal incidence of complete heart block. The long-term function of the aortic valve, intraventricular tunnels, conduits, and ventricles requires close surveillance. #

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Section: Discussionsupporting

confidence: 55%

Section: Issues Related To Asomentioning

confidence: 99%

Functional outcome of anatomic correction of corrected transposition of the great arteries☆

Hraška

Mattes

Haun

et al. 2011

European Journal of Cardio-Thoracic Surgery

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“…It could be postulated that either relocation of the (morphologically) left ventricle in the systemic position or cardiac transplantation is the surgical treatment of choice in these cases; however, results after relocation of the left ventricle into the systemic position, in terms of survival and benefit, are discouraging in the adult population with transposition of the great arteries. 28,29 The option of cardiac transplantation is probably the superior option from a functional point of view. Unfortunately, donor organs are scarce, and cardiac transplantation can only be applied in a limited number of patients.…”

Section: Discussionmentioning

confidence: 99%

Tricuspid Valve Surgery in Adults With a Dysfunctional Systemic Right Ventricle

et al. 2009

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Background-In patients with a right ventricle (RV) in the systemic position, tricuspid valve surgery for regurgitation beyond adolescence is a subject of debate. The aim of the present study was to evaluate the complications, survival, and benefit of tricuspid surgery in adult patients with an atrium-level correction for transposition of the great arteries or congenitally corrected transposition of the great arteries. Methods and Results-All adult patients (nϭ16; 7 men, 9 women; age 35Ϯ11 years) who underwent tricuspid valvuloplasty (nϭ8) or replacement (nϭ8) in the period 1999 to 2008 were included. Complications and survival were analyzed, and postoperative changes in RV function and functional class were evaluated. Tricuspid regurgitation was graded 1 to 4 according to its severity, RV dysfunction was graded as 1 to 4 (1ϭno dysfunction to 4ϭsevere dysfunction), and functional status was determined according to New York Heart Association class. Although complications occurred in 11 patients, all could be managed adequately. Three patients died 109, 180, and 659 days after surgery, respectively, the first patient after tricuspid valve replacement and the latter 2 after tricuspid valvuloplasty. Overall, tricuspid valve function improved (from grade 3.1Ϯ0.8 to 0.9Ϯ1.0; Pϭ0.001) and functional class improved (from 2.7Ϯ0.6 to 2.1Ϯ0.8; Pϭ0.007), whereas RV function remained unchanged. After tricuspid valvuloplasty, however, recurrent moderate tricuspid valve regurgitation was observed frequently (nϭ3; 37%). Conclusions-Mortality is rather low after tricuspid surgery in adult patients with mild to moderate RV dysfunction. In general, tricuspid valve function and functional class improve significantly after surgery, and systemic RV function is preserved. Tricuspid valvuloplasty, however, is associated with a high rate of recurrence of regurgitation.

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“…Quinn et al showed that patients requiring LV retraining prior to anatomical repair may be more at risk of developing significant LV dysfunction than patients whose MLV remains at systemic pressure at birth. 15 Furthermore, some large studies also showed that some patients who met the criteria died or underwent heart transplantation due to severe LV dysfunction after anatomical repair (Table 1). 7,8 In fact, the latest follow-up echocardiography showed a mild decrease in MLV ejection fraction in the present case.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Retraining and Anatomic Correction in Teenage Patient With Congenitally Corrected Transposition of the Great Arteries

Honjo

Kawada

Akagi

et al. 2007

Circ J

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ince traditional repair of congenitally corrected transposition of the great arteries (ccTGA), by leaving a morphologically right ventricle in a systemic circuit, results in a high incidence of late right ventricular dysfunction and tricuspid valve insufficiency, 1,2 an anatomic repair, ie, a double switch operation, is considered to be a superior alternative in order to improve the long-term survival of this patient population. [3][4][5][6][7][8][9] Nonetheless, a morphological left ventricle (MLV) should have an adequate pressure and ventricular mass to sustain a systemic circulation before anatomical repair, and retraining of the MLV by means of pulmonary artery banding (PAB) is necessary in some patients with a deconditioned MLV. Left ventricular (LV) retraining in older children is particularly challenging because of the striking difference in response to an increase in pressure overload between an immature growing myocardium and a matured myocardium. 10 Herein, we report a retraining process of the MLV in a teenage patient with ccTGA with intact ventricular septum with reference to the response of the MLV to the preliminary PAB. Case ReportA 1-year-old boy was diagnosed with ccTGA with an intact ventricular septum. The patient remained asymptomatic Circulation Journal Vol.71, April 2007without medication and was monitored by a cardiologist. He was referred to our institute at 7 years of age and cardiac catheterization revealed a low pressure of the MLV (33/4 mmHg) and a LV to right ventricular pressure ratio (LVp/RVp ratio) of 0.32. Moderate tricuspid regurgitation was evident. Echocardiography showed a LV posterior wall thickness in diastole (LVPWTd) of 4.5 mm in diameter and a LV mass index (LVMI) of 59 g/m 2 . The patient was scheduled for LV retraining to achieve anatomical repair.The first PAB was performed at the age of 10 years. During surgery, the LV systolic pressure was 33 mmHg with a peripheral systolic arterial pressure of 100 mmHg. The pulmonary artery was approached via median sternotomy. The method used for PAB was similar to that described by Mee and colleagues. [11][12][13] The main pulmonary trunk was encircled with a 3-mm-wide band, and the band was gradually tightened until the LVp/RVp ratio had reached 0.8. There was no evidence of acute LV dysfunction after the PAB. At catheterization 2 weeks later (Table 1), the LVp/RVp ratio was 0.68 and there was a pressure gradient of 32 mmHg across the banding. Tricuspid valve regurgitation decreased after the PAB. Despite that further effects from the PAB were expected, the follow-up study 1 year later revealed a minimal increase in the LVPWTd (6.2 mm in diameter), no increase in the LVMI and an unchanged LVp/RVp ratio (Figs 1,2). Also, there was no significant rise in the MLV pressure with dobutamine stimulation. The MLV was not considered to have the capacity to allow for the anatomical repair to be performed, and the patient was scheduled for a second PAB.The second PAB was performed at 12 years of age, 2 years after the initial PAB. The LV w...

show abstract

The morphologic left ventricle that requires training by means of pulmonary artery banding before the double-switch procedure for congenitally corrected transposition of the great arteries is at risk of late dysfunction

Cited by 93 publications

References 31 publications

Functional outcome of anatomic correction of corrected transposition of the great arteries☆

Functional outcome of anatomic correction of corrected transposition of the great arteries☆

Tricuspid Valve Surgery in Adults With a Dysfunctional Systemic Right Ventricle

Left Ventricular Retraining and Anatomic Correction in Teenage Patient With Congenitally Corrected Transposition of the Great Arteries

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