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Lee S, Kim CH, Lee JH, Kwak JG. Valve-Sparing Neo-Aortic Root Replacement for Neo-Aortic Root Dilatation 20 Years after Arterial Switch Operation for Transposition of the Great Arteries: A Case Report. J Chest Surg 2023; 56:445-448. [PMID: 37574885 PMCID: PMC10625968 DOI: 10.5090/jcs.23.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
A 25-year-old man returned to Seoul National University Children's Hospital with mild dyspnea on exertion. He had undergone an arterial switch operation at 1 month after birth to correct a complete transposition of the great arteries and a ventricular septal defect. When the patient was 15 years old, dilatation of the neo-aortic sinus and annulus was first identified; since then, it had gradually increased. Given the young age of the patient and the degree of aortic regurgitation (AR), which was mild to moderate, we opted to perform a valve-sparing neo-aortic root replacement with aortic valve repair. Postoperative echocardiography showed successful reductions in the sizes of the aortic sinus and annulus, with only mild AR remaining.
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Affiliation(s)
- Sangjun Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chan Hyeong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hong Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Ayala R, Dudakova M, Reeg H, Bauer U, Stiller B, Kubicki R, Kari FA. Impact of different neo-pulmonary artery surgical reconstruction techniques during the arterial switch operation on right ventricular outflow tract obstruction. A multicenter study up to 34-years' follow-up. PROGRESS IN PEDIATRIC CARDIOLOGY 2023. [DOI: 10.1016/j.ppedcard.2023.101638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Kupferschmid JP, Turek JW, Hughes GC, Austin EH, Alsoufi B, Smith JM, Scholl FG, Rankin JS, Badhwar V, Chen JM, Nuri MA, Romano JC, Ohye RG, Si MS. Early Outcomes of Patients Undergoing Neoaortic Valve Repair Incorporating Geometric Ring Annuloplasty. World J Pediatr Congenit Heart Surg 2022; 13:304-309. [PMID: 35446224 DOI: 10.1177/21501351221079523] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES During congenital heart surgery, the pulmonary valve and root may be placed into the systemic position, yielding a "neoaortic" valve. With the stress of systemic pressure, the pulmonary roots can dilate, creating aneurysms and/or neoaortic insufficiency (neoAI). This report analyzes the early outcomes of patients undergoing neoaortic valve repair incorporating geometric ring annuloplasty. METHODS Twenty-one patients underwent intended repair at six centers and formed the study cohort. Thirteen had previous Ross procedures, five had arterial switch operations, and three Fontan physiology. Average age was 21.7 ± 12.8 years (mean ± SD), 80% were male, and 11 (55%) had symptomatic heart failure. Preoperative neoAI Grade was 3.1 ± 1.1, and annular diameter was 30.7 ± 6.5 mm. RESULTS Valve repair was accomplished in 20/21, using geometric annuloplasty rings and leaflet plication (n = 13) and/or nodular release (n = 7). Fourteen had neoaortic aneurysm replacement (13 with root remodeling). Two underwent bicuspid valve repair. Six had pulmonary conduit changes, one insertion of an artificial Nodulus Arantius, and one resection of a subaortic membrane. Ring size averaged 21.9 ± 2.3 mm, and aortic clamp time was 171 ± 54 minutes. No operative mortality or major morbidity occurred, and postoperative hospitalization was 4.3 ± 1.4 days. At discharge, neoAI grade was 0.2 ± 0.4 (P < .0001), and valve mean gradient was ≤20 mm Hg. At average 18.0 ± 9.1 months of follow-up, all patients were asymptomatic with stable valve function. CONCLUSIONS Neoaortic aneurysms and neoAI are occasionally seen late following Ross, arterial switch, or Fontan procedures. Neoaortic valve repair using geometric ring annuloplasty, leaflet reconstruction, and root remodeling provides a patient-specific approach with favorable early outcomes.
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Affiliation(s)
| | | | - G Chad Hughes
- 22957Duke University Medical Center, Durham, NC, USA
| | | | | | | | - Frank G Scholl
- Joe Dimaggio 24931Children's Hospital, Hollywood, FL, USA
| | | | | | - Jonathan M Chen
- 24931Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Muhammad A Nuri
- 24931Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Patel PM, Herrmann JL, Bain E, Ladowski JM, Colgate C, Rodefeld MD, Turrentine MW, Brown JW. Risk Factors for Reoperation After Arterial Switch Operation. World J Pediatr Congenit Heart Surg 2021; 12:463-470. [PMID: 34278862 DOI: 10.1177/21501351211009768] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The timing and nature of and risk factors for reoperation after the arterial switch operation in the setting of d-transposition of the great arteries requires further elucidation. METHODS A total of 403 patients who underwent arterial switch operation from 1986 to 2017 were reviewed. Institutional preference was for pulmonary artery reconstruction using a pantaloon patch of fresh autologous pericardium. The targets for coronary artery reimplantation were identified by intermittent root distension. Multivariable analysis was used to identify risk factors for reoperation. RESULTS Median follow-up was 8.6 years (interquartile range [IQR]: 2-16.9). Pulmonary arterioplasty was the most common reoperation (n = 11, 2.7%) at 3.3 years (IQR: 1.4-11.4) postoperatively. Subvalvar right ventricular outflow tract reconstruction (RVOTR) was required in nine (2.2%) patients at 2.5 years (IQR: 1.1-5.3) postoperatively. Aortic valve repair or replacement (AVR/r) was required in seven (1.7%) patients at 13.6 years (IQR: 10.0-15.8) postoperatively. Aortic root replacement (ARR) and Coronary Artery Bypass Graft/coronary patch arterioplasty were required in five (1.2%) patients each at 13.6 years (IQR: 11.0-15.3) and 11.3 years (IQR: 2.3-13.6) postoperatively, respectively. Taussig-Bing anomaly was a risk factor for any reoperation (P = .034). Risk factors for specific reoperations included ventricular septal defect for AVR/r (P = .038), Taussig-Bing anomaly for RVOTR (P = .004), and pulmonary artery banding for ARR (P = .028). CONCLUSIONS Pantaloon patch pulmonary artery reconstruction and intermittent neo-aortic root distension during coronary reimplantation have minimized respective outflow tract reoperations. Certain anatomic subsets carry different risks for late reoperation, and pulmonary artery and/or RVOT reinterventions tend to occur sooner than aortic reinterventions. Special attention to these higher risk subpopulations will be critical to optimizing lifelong outcomes.
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Affiliation(s)
- Parth M Patel
- Division of Thoracic and Cardiovascular Surgery, 12250Indiana University School of Medicine, Indianapolis, IN, USA.,* These two authors contributed equally to this work
| | - Jeremy L Herrmann
- Division of Thoracic and Cardiovascular Surgery, 12250Indiana University School of Medicine, Indianapolis, IN, USA.,22536Riley Children's Health at Indiana University Health, Indianapolis, IN, USA.,* These two authors contributed equally to this work
| | - Eric Bain
- Division of Thoracic and Cardiovascular Surgery, 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joseph M Ladowski
- Division of Thoracic and Cardiovascular Surgery, 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | - Cameron Colgate
- Division of Thoracic and Cardiovascular Surgery, 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark D Rodefeld
- Division of Thoracic and Cardiovascular Surgery, 12250Indiana University School of Medicine, Indianapolis, IN, USA.,22536Riley Children's Health at Indiana University Health, Indianapolis, IN, USA
| | - Mark W Turrentine
- Division of Thoracic and Cardiovascular Surgery, 12250Indiana University School of Medicine, Indianapolis, IN, USA.,22536Riley Children's Health at Indiana University Health, Indianapolis, IN, USA
| | - John W Brown
- Division of Thoracic and Cardiovascular Surgery, 12250Indiana University School of Medicine, Indianapolis, IN, USA.,22536Riley Children's Health at Indiana University Health, Indianapolis, IN, USA
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Moll M, Moll JA, Moll JJ, Łubisz M, Michalak KW. Intramural coronary pattern in patients with transposition: incidence and impact on follow-up. Eur J Cardiothorac Surg 2021; 58:145-152. [PMID: 32057070 DOI: 10.1093/ejcts/ezaa021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/22/2019] [Accepted: 01/04/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Coronary complications are still the main reason for early mortality after an arterial switch operation. The high incidence of coronary anomalies in patients with transposition of the great arteries may increase the difficulty of coronary transfer, and among them, an intramural pattern was shown to be an independent risk factor of early mortality. However, recently published studies have reported that this rare coronary variant has no impact on the survival rate. The aim of this study was to assess the frequency of intramural coronary patterns in patients with transposition and the impact on overall mortality after an arterial switch operation. Additionally, we presented all coronary arrangements associated with intramural patterns in our cohort and the surgical techniques used to manage them successfully. METHODS All arterial switch operations were retrospectively reviewed. In each case, the surgical reports contained detailed graphical representations and coronary anatomy patterns. All operatively confirmed intramural patterns were included in the analysis. RESULTS Among 806 patients, 271 patients had coronary anomalies (33.62%), and 28 patients had an intramural pattern (3.47%), which was frequently associated with other complex coronary anomalies (P < 0.001). Overall survival was significantly higher in patients with intramural coronary artery patterns than in those with other coronary variants (21.34% vs 8.74%, P = 0.024, log-rank test). CONCLUSIONS Intramural patterns associated with transposition remain a surgical challenge and increase overall mortality in our cohort. To reliably confirm or reject the significance of the observed impact of this rare coronary variant, a multicentre data analysis is required.
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Affiliation(s)
- Maciej Moll
- Department of Cardiac Surgery, Polish Mother's Memorial Hospital, Research Institute, Lodz, Poland
| | - Jadwiga A Moll
- Department of Cardiology, Polish Mother's Memorial Hospital, Research Institute, Lodz, Poland
| | - Jacek J Moll
- Department of Cardiac Surgery, Polish Mother's Memorial Hospital, Research Institute, Lodz, Poland
| | - Monika Łubisz
- Department of Cardiology, Polish Mother's Memorial Hospital, Research Institute, Lodz, Poland
| | - Krzysztof W Michalak
- Department of Cardiology, Polish Mother's Memorial Hospital, Research Institute, Lodz, Poland
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Kim H. Growth Pattern of the Neo-Aorta after Arterial Switch Operation: What Is the Factor of Determination? Korean Circ J 2021; 51:94-96. [PMID: 33377331 PMCID: PMC7779818 DOI: 10.4070/kcj.2020.0494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hyungtae Kim
- Department of Thoracic and Cardiovascular Surgery, Research institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
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Pewowaruk R, Hermsen J, Johnson C, Erdmann A, Pettit K, Aesif S, Ralphe JC, Francois CJ, Roldán-Alzate A, Lamers L. Pulmonary artery and lung parenchymal growth following early versus delayed stent interventions in a swine pulmonary artery stenosis model. Catheter Cardiovasc Interv 2020; 96:1454-1464. [PMID: 33063918 PMCID: PMC10831906 DOI: 10.1002/ccd.29326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Compare lung parenchymal and pulmonary artery (PA) growth and hemodynamics following early and delayed PA stent interventions for treatment of unilateral branch PA stenosis (PAS) in swine. BACKGROUND How the pulmonary circulation remodels in response to different durations of hypoperfusion and how much growth and function can be recovered with catheter directed interventions at differing time periods of lung development is not understood. METHODS A total of 18 swine were assigned to four groups: Sham (n = 4), untreated left PAS (LPAS) (n = 4), early intervention (EI) (n = 5), and delayed intervention (DI) (n = 5). EI had left pulmonary artery (LPA) stenting at 5 weeks (6 kg) with redilation at 10 weeks. DI had stenting at 10 weeks. All underwent right heart catheterization, computed tomography, magnetic resonance imaging, and histology at 20 weeks (55 kg). RESULTS EI decreased the extent of histologic changes in the left lung as DI had marked alveolar septal and bronchovascular abnormalities (p = .05 and p < .05 vs. sham) that were less prevalent in EI. EI also increased left lung volumes and alveolar counts compared to DI. EI and DI equally restored LPA pulsatility, R heart pressures, and distal LPA growth. EI and DI improved, but did not normalize LPA stenosis diameter (LPA/DAo ratio: Sham 1.27 ± 0.11 mm/mm, DI 0.88 ± 0.10 mm/mm, EI 1.01 ± 0.09 mm/mm) and pulmonary blood flow distributions (LPA-flow%: Sham 52 ± 5%, LPAS 7 ± 2%, DI 44 ± 3%, EI 40 ± 2%). CONCLUSION In this surgically created PAS model, EI was associated with improved lung parenchymal development compared to DI. Longer durations of L lung hypoperfusion did not detrimentally affect PA growth and R heart hemodynamics. Functional and anatomical discrepancies persist despite successful stent interventions that warrant additional investigation.
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Affiliation(s)
- Ryan Pewowaruk
- Biomedical Engineering, University of Wisconsin – Madison
| | - Joshua Hermsen
- School of Medicine and Public Health, University of Wisconsin – Madison
- Cardiovascular Surgery, University of Wisconsin – Madison
| | | | - Alexandra Erdmann
- School of Medicine and Public Health, University of Wisconsin – Madison
| | - Kevin Pettit
- School of Medicine and Public Health, University of Wisconsin – Madison
| | - Scott Aesif
- School of Medicine and Public Health, University of Wisconsin – Madison
- Pathology, University of Wisconsin – Madison
| | - J. Carter Ralphe
- School of Medicine and Public Health, University of Wisconsin – Madison
- Pediatrics, Division of Cardiology, University of Wisconsin – Madison
| | - Christopher J. Francois
- School of Medicine and Public Health, University of Wisconsin – Madison
- Radiology, University of Wisconsin – Madison
| | - Alejandro Roldán-Alzate
- Biomedical Engineering, University of Wisconsin – Madison
- Mechanical Engineering, University of Wisconsin – Madison
- Radiology, University of Wisconsin – Madison
| | - Luke Lamers
- School of Medicine and Public Health, University of Wisconsin – Madison
- Pediatrics, Division of Cardiology, University of Wisconsin – Madison
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Predictors of neo-aortic valve regurgitation in the long term after arterial switch operation. Heart Vessels 2020; 36:693-703. [PMID: 33245489 DOI: 10.1007/s00380-020-01729-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
Although arterial switch operations (ASOs) have been performed globally to repair d-transposition of the great arteries (d-TGA) in neonates and infants, few studies have been reported regarding the influence of the hemodynamics of patients with d-TGA who have undergone ASO on the development of neo-aortic valve regurgitation (AR). We aimed to investigate the relationship between the hemodynamics and development of AR after ASO in patients with d-TGA by catheter evaluation. This observational study screened 114 consecutive patients who underwent ASO for d-TGA or Taussig-Bing anomaly and who subsequently underwent catheter evaluations in our institution. We reviewed their records for the past 20 years and collected their first catheterization data post-ASO in early childhood. Thirty-six post-ASO patients who underwent catheter evaluations in both the early surgical and long-term phases were finally analyzed. Patients were divided into the following groups according to the presence of significant AR in the long-term phase: the AR group (n = 9 with AR ≥ grade II by the Sellers classification) and the non-AR group (n = 27 with AR < grade II). In the long-term phase, the diastolic blood pressure was significantly lower and the ascending aortic diameter was significantly larger in the AR group than in the non-AR group (p = 0.004 and p = 0.006, respectively). The systolic blood pressure (SBP) and pulse pressure (PP) were similar in both groups. Meanwhile, in the early surgical phase, SBP and PP were significantly higher in the AR group than in the non-AR group (p = 0.029 and p = 0.002, respectively). The receiver operating characteristic curve for late AR showed that the area under the curve for SBP and PP in the early surgical phase were 0.746 and 0.853, respectively. Even though sensitivity analysis was performed, SBP or PP greater than the cutoff value in the early surgical phase was identified as predictors for late AR. Our results suggested that high SBP or PP in the early surgical phase could influence the development of AR in the long term after ASO.
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9
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Mosca R, Chen D, Halpern D, Ma C, Feinberg J, Bhatla P, Kumar TKS. Femoral artery homograft for coronary artery plasty following arterial switch operation. JTCVS Tech 2020; 4:232-234. [PMID: 34318024 PMCID: PMC8303055 DOI: 10.1016/j.xjtc.2020.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 07/29/2020] [Accepted: 08/10/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ralph Mosca
- Department of Congenital Cardiothoracic Surgery, NYU Langone Health, New York, NY
| | - David Chen
- Department of Congenital Cardiothoracic Surgery, NYU Langone Health, New York, NY
| | - Dan Halpern
- Department of Cardiology, NYU Langone Health, New York, NY
| | - Charles Ma
- Department of Congenital Cardiothoracic Surgery, NYU Langone Health, New York, NY
| | - Jodi Feinberg
- Department of Cardiology, NYU Langone Health, New York, NY
| | - Puneet Bhatla
- Department of Cardiology, NYU Langone Health, New York, NY
| | - T K Susheel Kumar
- Department of Congenital Cardiothoracic Surgery, NYU Langone Health, New York, NY
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10
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The influence of coronary artery anatomy on mortality after the arterial switch operation. J Thorac Cardiovasc Surg 2020; 160:191-199.e1. [DOI: 10.1016/j.jtcvs.2019.11.146] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 11/24/2019] [Accepted: 11/26/2019] [Indexed: 11/22/2022]
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Dedemoğlu M, Korun O, Coşkun G, Özdemir F, Yurdakök O, Çiçek M, Biçer M, Yurtseven N, Şaşmazel A, Aydemir NA. The poor long-term outcomes of owl's eye pulmonary reconstruction technique after arterial switch operation. Interact Cardiovasc Thorac Surg 2020; 31:113-120. [PMID: 32500154 DOI: 10.1093/icvts/ivaa067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/18/2020] [Accepted: 03/21/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study aims to compare the early- and long-term outcomes of patients who undergo owl's eye pulmonary artery (PA) reconstruction to those of patients who undergo conventional PA reconstruction. METHODS From January 2016 to January 2017, 64 consecutive patients underwent an arterial switch operation. The patients were divided into 2 groups in terms of neo-PA reconstruction method: 30 patients who underwent neo-PA reconstruction by owl's eye technique were defined as group 1 and 34 patients who underwent neo-PA reconstruction by the conventional approach were defined as group 2. In the final model, after propensity matching, 23 patients from each group with similar propensity scores were included in the study. RESULTS There was no significant difference between the groups regarding patient characteristics and operative findings. In the early period, the duration of intensive care unit and hospital stays and the rate of mild neo-pulmonary stenosis (neo-PS) were significantly higher in the owl's eye group (P = 0.04, 0.04 and 0.03). In the late period, the rate of severe neo-PS and reintervention was significantly higher in the owl's eye group (P = 0.02 and 0.04). Furthermore, the rates of 3-year freedom from pulmonary reintervention and freedom from moderate-severe neo-PS were significantly lower in group 1 (P = 0.04). In addition, the owl's eye reconstruction was the only factor independently related to moderate-severe neo-PS in the long term (hazard ratios = 11.2, P = 0.02). CONCLUSIONS We have abandoned the owl's eye method for neo-PA reconstruction of the neo-PA because of serious complications. According to our series and the literature, reconstruction of the neo-PA with an oversized, pantaloon-shaped fresh autologous pericardial patch is still superior to the other techniques.
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Affiliation(s)
- Mehmet Dedemoğlu
- Department of Pediatric Cardiovascular Surgery, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Oktay Korun
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Gültekin Coşkun
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Fatih Özdemir
- Department of Pediatric Cardiovascular Surgery, Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey
| | - Okan Yurdakök
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Çiçek
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Biçer
- Department of Pediatric Cardiovascular Surgery, Health Sciences University Erzurum Region Education and Research Hospital, Erzurum, Turkey
| | - Nurgül Yurtseven
- Department of Anesthesia and Reanimation, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Şaşmazel
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Numan Ali Aydemir
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Choi KH, Sung SC, Kim H, Lee HD, Kim G, Ko H, Byun JH, Lee YS. Does Coronary Reimplantation After Neoaortic Reconstruction Increase Aortic Regurgitation? Pediatr Cardiol 2019; 40:813-819. [PMID: 30778636 DOI: 10.1007/s00246-019-02075-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 09/29/2018] [Indexed: 11/26/2022]
Abstract
Coronary reimplantation after neoaortic reconstruction (CRANR) in the arterial switch operation (ASO) allows easy selection of accurate coronary transfer sites in the distended neoaorta. However, neoaortic valve injury may occur during coronary reimplantation. We determined whether the CRANR procedure increased the incidence of aortic valve regurgitation (AR) after ASO. Between March 1994 and August 2017, 227 patients underwent ASO. Since September 2000 CRANR has been performed on 155 patients and open coronary reimplantation (OCR) on 72. Patients who had undergone aortocoronary flaps procedures (n = 13), had early or late mortality (n = 27), or lacked data (n = 11) were excluded. We enrolled and retrospectively reviewed the medical records of 176 patients who were followed up for postoperative AR: 38 underwent OCR and 138 underwent CRANR. We compared the incidences of early and late postoperative AR in both groups. We defined mild or greater AR as "significant AR." The groups did not differ in body weight at operation, great artery relationship, and coronary artery anatomy. The incidences of significant AR at discharge were 21.1% (8/38) in the OCR group and 16.6% (23/138) in the CRANR group (p = 0.53). The freedom from significant AR at 5 years was 59.9% in the OCR group and 62.4% in the CRANR group with no difference between the two groups (p = 0.73). Moderate AR occurred in one patient in the CRANR group. No surgical intervention was required for the aortic valve in either group. ASO using the CRANR technique did not increase the incidence of postoperative early and late AR.
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Affiliation(s)
- Kwang Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Mulgeum-eup, Yangsan, Gyeongsangnam, 50612, Republic of Korea
| | - Si Chan Sung
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Mulgeum-eup, Yangsan, Gyeongsangnam, 50612, Republic of Korea.
| | - Hyungtae Kim
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Mulgeum-eup, Yangsan, Gyeongsangnam, 50612, Republic of Korea
| | - Hyoung Doo Lee
- Department of Pediatrics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Geena Kim
- Department of Pediatrics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hoon Ko
- Department of Pediatrics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Joung-Hee Byun
- Department of Pediatrics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Young Seok Lee
- Department of Pediatrics, Dong-A University Hospital, Busan, South Korea
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Long-Term Growth of the Neoaortic Root After Arterial Switch Operation. Ann Thorac Surg 2019; 107:1203-1211. [DOI: 10.1016/j.athoracsur.2018.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 07/26/2018] [Accepted: 09/12/2018] [Indexed: 11/17/2022]
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14
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Martins CN, Gontijo Filho B, Lopes RM, Silva FDCLE. Mid- and Longterm Neo-Aortic Valve Regurgitation after Jatene Surgery: Prevalence and Risk Factors. Arq Bras Cardiol 2018; 111:21-28. [PMID: 29972413 PMCID: PMC6078373 DOI: 10.5935/abc.20180111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 04/25/2018] [Indexed: 11/20/2022] Open
Abstract
Background Jatene surgery became the surgical procedure of choice to repair
transposition of the great arteries (TGA) in neonates and infants. Late
complications, mainly related to the pulmonary outflow tract and coronary
arteries, are well known. The behavior of the neo-aortic valve is a cause of
concern because of its potential for requiring late reoperation. Objectives To assess the prevalence and risk factors of neo-aortic valve regurgitation
in 127 patients in the late postoperative period of the Jatene surgery. Methods Of the 328 survivors of the Jatene surgery at the Biocor Institute from
October 1997 to June 2015, all patients undergoing postoperative follow-up
were contacted via telephone, 127 being eligible for the study. The patients
were divided into two groups, simple TGA and complex TGA groups, with
follow-up means of 6.4 ± 4.7 years and 9.26 ± 4.22 years,
respectively. Echocardiography was performed with adjusted measurements
(Z-score) of the neo-aortic annulus, sinus of Valsalva, sinotubular region
and ascending aorta, as well as quantification of the neo-aortic valve
regurgitation grade. Results The incidence of mild neo-aortic valve regurgitation was 29% in a follow-up
of 7.4 ± 4.7 years. Moderate regurgitation was identified in 24
patients with age mean (± standard-deviation) of 9.81 ± 4.21
years, 19 of whom (79%) in the complex TGA group. Those patients had a
higher aortic annulus Z-score. The reoperation rate due to neo-aortic
regurgitation associated with aortic dilation was 1.5%, all patients in the
complex TGA group. Conclusion This study shows that, despite the low incidence of reoperation after Jatene
surgery due to neo-aorta dilation and neo-aortic valve regurgitation, that
is a time-dependent phenomenon, which requires strict vigilance of the
patients. In this study, one of the major risk factors for neo-aortic valve
regurgitation was the preoperative pulmonary artery diameter (p <
0.001).
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Affiliation(s)
| | | | - Roberto Max Lopes
- BIOCOR Hospital de Doenças Cardiovasculares, Belo Horizonte, MG - Brazil
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15
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Michalak KW, Moll M, Moszura T, Moll JJ. Successful Late Recruitment of the Occluded Left Main Coronary Artery After Initial Arterial Switch Operation. World J Pediatr Congenit Heart Surg 2018; 9:344-346. [PMID: 29697021 DOI: 10.1177/2150135118757989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We describe a surgical technique for late recruitment of the proximally occluded left main coronary artery (LMCA) after initial arterial switch operation, which had been complicated by severe left ventricular dysfunction. This technique allowed for LMCA recanalization, using the patent conal artery branching off the LMCA close to the ostium. It is particularly useful in small children, where surgical options for coronary arteries are limited and associated with a high risk of restenosis. It was successfully used in a two-month-old boy with successful revascularization confirmed by angiography.
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Affiliation(s)
| | - Maciej Moll
- 2 Department of Cardiac Surgery, Polish Mother's Memorial Hospital, Lodz, Poland
| | - Tomasz Moszura
- 1 Department of Cardiology, Polish Mother's Memorial Hospital, Lodz, Poland
| | - Jacek Jan Moll
- 2 Department of Cardiac Surgery, Polish Mother's Memorial Hospital, Lodz, Poland
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16
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Yoneyama F, Okamura T, Harada Y, Okita Y. Valve-sparing reimplantation for neoaortic root dilatation and regurgitation with an unbalanced cusp after the arterial switch operation. J Card Surg 2018; 33:122-125. [DOI: 10.1111/jocs.13543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Fumiya Yoneyama
- Department of Cardiovascular Surgery; Kobe University Graduate School of Medicine; Japan
| | - Toru Okamura
- Department of Cardiovascular Surgery; Kobe University Graduate School of Medicine; Japan
| | - Yorikazu Harada
- Department of Cardiovascular Surgery; Kobe University Graduate School of Medicine; Japan
| | - Yutaka Okita
- Kobe University Graduate School of Medicine; Nagano Children's Hospital; Japan
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17
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Szymczyk K, Moll M, Sobczak-Budlewska K, Moll JA, Stefańczyk L, Grzelak P, Moll JJ, Michalak KW. Usefulness of Routine Coronary CT Angiography in Patients with Transposition of the Great Arteries After an Arterial Switch Operation. Pediatr Cardiol 2018; 39:335-346. [PMID: 29090351 PMCID: PMC5797754 DOI: 10.1007/s00246-017-1761-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/25/2017] [Indexed: 11/25/2022]
Abstract
Coronary complications in patients with transposition of the great arteries (TGA) after an arterial switch operation (ASO) are relatively rare, but of all the possible postoperative adverse events, they are potentially the most dangerous. The fate of the coronary arteries, which are transplanted during the neonatal ASO, remains uncertain. There is also no consensus regarding their postoperative evaluation, especially in asymptomatic patients. The aim of this study was to present the early results of routinely performed coronary computed tomography angiography (CCTA) in asymptomatic adolescents and young adults with TGA after an ASO. An initial series of 50 CCTAs performed in asymptomatic patients with TGA after an ASO were evaluated. In each case, a detailed examination of the coronary anatomy, its relationship to the surrounding structures, its exact position in the neoaortic sinus, and the presence of significant coronary abnormalities was performed. The CT scans revealed significant coronary abnormalities in 12 asymptomatic patients: three had acute proximal angulation and stenosis, four had an intra-arterial course, seven had a muscular bridge, one had a left anterior descending artery with an intramuscular course, and one had coronary fistulas to the pulmonary arteries. Additionally, in 25 patients, proximal acute angulation of at least one coronary artery was detected, and four of them had a high ellipticity index. Most of the potentially severe anatomical features were related to the left coronary artery or the left anterior descending artery. CCTA routinely performed on asymptomatic patients with TGA after an ASO provides accurate and useful information for postoperative management. The frequency of coronary anomalies and potentially dangerous anatomical features in this group of patients is high, and their impact on postoperative follow-up remains unknown.
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Affiliation(s)
- Konrad Szymczyk
- Department of Diagnostic Imaging, Medical University, Lodz, Poland
| | - Maciej Moll
- Department of Cardiac Surgery, Polish Mother's Memorial Hospital, Lodz, Poland
| | - Katarzyna Sobczak-Budlewska
- Department of Cardiology, Polish Mother's Memorial Hospital, Research Institute, ul. Rzgowska 281/289, 93-338, Lodz, Poland
| | - Jadwiga A Moll
- Department of Cardiology, Polish Mother's Memorial Hospital, Research Institute, ul. Rzgowska 281/289, 93-338, Lodz, Poland
| | | | - Piotr Grzelak
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital, Lodz, Poland
| | - Jacek J Moll
- Department of Cardiac Surgery, Polish Mother's Memorial Hospital, Lodz, Poland
| | - Krzysztof W Michalak
- Department of Cardiology, Polish Mother's Memorial Hospital, Research Institute, ul. Rzgowska 281/289, 93-338, Lodz, Poland.
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18
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Coronary Artery Anomalies in Patients With Transposition of the Great Arteries and Their Impact on Postoperative Outcomes. Ann Thorac Surg 2017. [PMID: 28648541 DOI: 10.1016/j.athoracsur.2017.03.078] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Coronary anomalies are frequently present in children with transposition of the great arteries (TGA). Such anomalies significantly increase the complexity of arterial switch operations and may have an effect on postoperative outcomes. In this study, we aimed to assess the frequency of coronary anomalies in children with TGA and describe their effect on postoperative outcomes. METHODS All patients with TGA who underwent an arterial switch operation between 1991 and 2015 were consecutively enrolled in this study. Patient coronary patterns were obtained from corresponding operative reports and analyzed to determine their associations with adverse postoperative outcomes. RESULTS The study included 715 patients with isolated and complex TGA. Coronary anomalies were present in 33.7% of patients and were significantly correlated with the side-by-side configuration of the great arteries. Coronary sinuses with more than 1 ostium were associated with a significantly increased risk of postoperative death (hazard ratio [HR], 2.58), and coronary arteries with a single ostium were associated with an increased risk of postoperative reinterventions (HR, 2.49). In contrast, the trap-door technique of coronary artery transplantation was associated with a reduced risk of reinterventions during postoperative follow-up (HR, 0.40). Complex coronary anomalies were significantly associated with postoperative coronary events (HR, 2.12). CONCLUSIONS With the exception of patients whose circumflex artery branches off of the right coronary artery, an anomaly that clearly has no effect on postoperative follow-up, patients with unusual coronary patterns are at higher risk for adverse postoperative outcomes than patients with normal coronary anatomy and must be monitored carefully.
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19
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Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum. Cardiol Young 2017; 27:530-569. [PMID: 28249633 DOI: 10.1017/s1047951117000014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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20
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Sarris GE, Balmer C, Bonou P, Comas JV, da Cruz E, Chiara LD, Di Donato RM, Fragata J, Jokinen TE, Kirvassilis G, Lytrivi I, Milojevic M, Sharland G, Siepe M, Stein J, Büchel EV, Vouhé PR. Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum. Eur J Cardiothorac Surg 2017; 51:e1-e32. [DOI: 10.1093/ejcts/ezw360] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Na KJ, Kim WH, Jang WS, Choi ES, Cho S. Transeptal Aortic Valve Replacement After Arterial Switch in a Patient With Taussig-Bing Anomaly. Ann Thorac Surg 2015; 100:307-9. [PMID: 26140775 DOI: 10.1016/j.athoracsur.2014.08.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 08/03/2014] [Accepted: 08/15/2014] [Indexed: 11/29/2022]
Abstract
Aortic valve replacement in patients after arterial switch is technically difficult, especially in patients with small aorta without neoaortic regurgitation. We report a patient with Taussig-Bing anomaly who had fungal endocarditis after several cardiac operations and was successfully treated with transeptal aortic valve replacement concomitant with other surgical and medical treatments.
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Affiliation(s)
- Kwon Joong Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, South Korea
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, South Korea.
| | - Woo Sung Jang
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Daegu, South Korea
| | - Eun Seok Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, South Korea
| | - Sungkyu Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, South Korea
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22
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Lo Rito M, Fittipaldi M, Haththotuwa R, Jones TJ, Khan N, Clift P, Brawn WJ, Barron DJ. Long-term fate of the aortic valve after an arterial switch operation. J Thorac Cardiovasc Surg 2015; 149:1089-94. [DOI: 10.1016/j.jtcvs.2014.11.075] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/29/2014] [Accepted: 11/28/2014] [Indexed: 11/25/2022]
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23
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Koolbergen DR, Manshanden JSJ, Yazdanbakhsh AP, Bouma BJ, Blom NA, de Mol BAJM, Mulder BJ, Hazekamp MG. Reoperation for neoaortic root pathology after the arterial switch operation. Eur J Cardiothorac Surg 2014; 46:474-9; discussion 479. [DOI: 10.1093/ejcts/ezu026] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Late complications and pathological findings of the arterial switch operation. Cardiol Young 2014; 24:167-9. [PMID: 23388218 DOI: 10.1017/s1047951113000085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We describe aortic root dilatation, severe aortic regurgitation, and pulmonary artery stenosis that were accidentally diagnosed 23 years after the arterial switch operation for transposition of the great arteries in situs inversus. We successfully performed the modified Bentall procedure and pulmonary artery reconstruction. The pathology of the dilated aortic root revealed intimal atherosclerosis and linear necrosis of the tunica media, suggesting the vulnerability of the pulmonary artery to systemic pressure.
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25
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Raju V, Burkhart HM, Durham LA, Eidem BW, Phillips SD, Li Z, Schaff HV, Dearani JA. Reoperation After Arterial Switch: A 27-Year Experience. Ann Thorac Surg 2013; 95:2105-12; discussion 2112-3. [DOI: 10.1016/j.athoracsur.2013.02.040] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 02/11/2013] [Accepted: 02/15/2013] [Indexed: 10/26/2022]
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26
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SCHNEIDER M, WIEBE W, HRAŠKA V, ZARTNER P. Coronary Interventions in Congenital Heart Diseases: From Preterm to Young Adult Patients. J Interv Cardiol 2013; 26:287-94. [DOI: 10.1111/j.1540-8183.2013.12015.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- M. SCHNEIDER
- Department of Cardiology; German Pediatric Heart Center; Sankt Augustin; Germany
| | - W. WIEBE
- Department of Cardiology; German Pediatric Heart Center; Sankt Augustin; Germany
| | - V. HRAŠKA
- Department of Cardiothoracic Surgery; German Pediatric Heart Center; Sankt Augustin; Germany
| | - P. ZARTNER
- Department of Cardiology; German Pediatric Heart Center; Sankt Augustin; Germany
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27
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Abstract
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.
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28
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29
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Lim HG, Kim WH, Lee JR, Kim YJ. Long-term results of the arterial switch operation for ventriculo-arterial discordance. Eur J Cardiothorac Surg 2012; 43:325-34. [DOI: 10.1093/ejcts/ezs264] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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