Two-Stage Arterial Switch Operation: Is Late Ever Too Late?

Qethamy, Howaida O Al; Aizaz, Khawar; Aboelnazar, Saber; Hijab, Samina; Faraidi, Yahya Al

doi:10.1177/021849230201000310

Cited by 9 publications

(10 citation statements)

References 21 publications

(21 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nevertheless, the decision to proceed to the arterial switch is based on the evolution of the echocardiografic parameters concerning both left ventricle structure and haemodynamic performance. The results reported appear to be very encouraging, showing a survival rate and freedom of reoperation at five years of 90% and 97%, respectively [ 38 ].…”

Section: Managementmentioning

confidence: 99%

Transposition of the great arteries

Martins¹,

Castela²

2008

Orphanet J Rare Dis

125

103

View full text Add to dashboard Cite

Transposition of the great arteries (TGA), also referred to as complete transposition, is a congenital cardiac malformation characterised by atrioventricular concordance and ventriculoarterial (VA) discordance. The incidence is estimated at 1 in 3,500-5,000 live births, with a male-to-female ratio 1.5 to 3.2:1. In 50% of cases, the VA discordance is an isolated finding. In 10% of cases, TGA is associated with noncardiac malformations. The association with other cardiac malformations such as ventricular septal defect (VSD) and left ventricular outflow tract obstruction is frequent and dictates timing and clinical presentation, which consists of cyanosis with or without congestive heart failure. The onset and severity depend on anatomical and functional variants that influence the degree of mixing between the two circulations. If no obstructive lesions are present and there is a large VSD, cyanosis may go undetected and only be perceived during episodes of crying or agitation. In these cases, signs of congestive heart failure prevail. The exact aetiology remains unknown. Some associated risk factors (gestational diabetes mellitus, maternal exposure to rodenticides and herbicides, maternal use of antiepileptic drugs) have been postulated. Mutations in growth differentiation factor-1 gene, the thyroid hormone receptor-associated protein-2 gene and the gene encoding the cryptic protein have been shown implicated in discordant VA connections, but they explain only a small minority of TGA cases.The diagnosis is confirmed by echocardiography, which also provides the morphological details required for future surgical management. Prenatal diagnosis by foetal echocardiography is possible and desirable, as it may improve the early neonatal management and reduce morbidity and mortality. Differential diagnosis includes other causes of central neonatal cyanosis. Palliative treatment with prostaglandin E1 and balloon atrial septostomy are usually required soon after birth. Surgical correction is performed at a later stage. Usually, the Jatene arterial switch operation is the procedure of choice. Whenever this operation is not feasible, adequate alternative surgical approach should be implemented. With the advent of newer and improved surgical techniques and post operative intensive care, the long-term survival is approximately 90% at 15 years of age. However, the exercise performance, cognitive function and quality of life may be impaired.

show abstract

Section: Managementmentioning

confidence: 99%

Transposition of the great arteries

Martins¹,

Castela²

2008

Orphanet J Rare Dis

125

103

View full text Add to dashboard Cite

show abstract

“…systemic-pulmonary shunt (usually a modified Blalock-Taussig anastomosis) followed by an ASO after an interval that depends on the patient's age [i.e. 1-2 weeks in young infants (rapid two-stage ASO) [105,117], or several months in older infants/children] [114,[120][121][122]. A moderate degree of both pressure and volume overload provides the most effective stimulus for ventricular hypertrophy, and a small-to-moderate ASD is advantageous to ensure the necessary volume preload for the left ventricle [123].…”

Section: Pulmonary Artery Banding Combined With Amentioning

confidence: 99%

Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum

Sarris¹,

Balmer²,

Bonou³

et al. 2017

Cardiol Young

View full text Add to dashboard Cite

The members of the Task Force have provided disclosure statements of all relationships that might be perceived as real or potential sources of conflicts of interest. These disclosure forms are kept on file at the headquarters of the EACTS/AEPC. The Committee report received its entire financial support from the EACTS and AEPC, without any involvement of the pharmaceutical, device or surgical industries

show abstract

“…, 18 The current guidelines indicating the adequacy of left ventricular training after pulmonary arterial banding include an inferior limit of left ventricular mass at 35 g/m 2 , 19 a left-to-right ventricular pressure ratio >0.85, left ventricular end-diastolic volume >90% of normal, or posterior wall thickness >4 mm, allowing for a safe arterial switch after debanding 20 . In developing countries and/or in situations with late diagnosis and referral, the time limits to perform an arterial switch with or without prior left ventricular training by banding are being redefined and vary depending on the presence or absence of a ventricular septal defect, 21 – 24 details of which are beyond the scope of this review. It is worth noting, however, that the age boundaries to directly perform an arterial switch without prior banding in babies with an intact ventricular septum have been pushed to 6 months 21 .…”

Section: The Presentmentioning

confidence: 99%

Past, present, and future of the arterial switch operation: historical review

Dodge‐Khatami¹,

Mavroudis

Jacobs³

2012

Cardiol Young

View full text Add to dashboard Cite

The arterial switch operation is the extant surgical correction after a long series of palliations attempted and/or successfully achieved for the treatment of discordant ventriculoarterial connections. As early as 1954, pioneers such as Mustard, Bailey, Kay, and Idriss led the way with at first disheartening failures, temporarily leading to abandoning the procedure. The first successful atrial baffle procedure in 1958 established itself as the procedure of choice for treating discordant ventriculoarterial connections, but tenacity, courage, and vision to pursue anatomic correction finally led to the first successful arterial switch in 1975 by Jatene. After a decade to perfect surgical technique and timing indications for the various anatomic subtypes, the new era of the neonatal arterial switch since the late 1980s set the very high standards that we all know and expect today. Despite excellent early and long-term survival, important residual lesions are increasingly being recognised. Expected anatomic residuals include supravalvar pulmonary stenosis, neoaortic valve insufficiency, and coronary ostial stenosis. Reinterventions and rare, but challenging surgical reoperations address these residual findings with satisfactory outcomes. Quality of life into young adulthood is satisfactory, but functional problems include reduced exercise capacity, diffuse coronary insufficiency, and neurodevelopmental shortcomings, of which the true incidence and potential clinical implications are still unknown. The arterial switch is a spectacular anatomic correction for a once lethal condition and currently the best surgical solution for patients with discordant ventriculoarterial connections. It is, however, far from a true cure; closer and ongoing follow-up for future care will continue to be required.

show abstract

Two-Stage Arterial Switch Operation: Is Late Ever Too Late?

Cited by 9 publications

References 21 publications

Transposition of the great arteries

Transposition of the great arteries

Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum

Past, present, and future of the arterial switch operation: historical review

Contact Info

Product

Resources

About