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Llerena-Velastegui J, Vaca-Perez P, Placencia-Silva M. The choice of palliative arterial switch operation as an alternative for selected cases in a single center: Experience and mid-term results. J Card Surg 2022; 37:5698. [PMID: 36208105 DOI: 10.1111/jocs.17008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 01/06/2023]
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Caruso E, Farruggio S, Raciti M, Agati S. Dextroversion and D-Transposition of the Great Arteries, Left-Handed Ventricular Topology Related to Multiple Ventricular Septal Defects, and Left Juxtaposition of Atrial Appendage in a 1-Year-Old Child. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2022. [DOI: 10.4103/jiae.jiae_50_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Zheng G, Wu J, Chen P, Hu Y, Zhang H, Wang J, Zeng H, Li X, Sun Y, Xu G, Wen S, Cen J, Chen J, Guo Y, Zhuang J. Characteristics of in-hospital mortality of congenital heart disease (CHD) after surgical treatment in children from 2005 to 2017: a single-center experience. BMC Pediatr 2021; 21:521. [PMID: 34814864 PMCID: PMC8609813 DOI: 10.1186/s12887-021-02935-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate trends in the in-hospital mortality rate for pediatric cardiac surgery procedures between 2005 and 2017 in our center, and to discuss the mortality characteristics of children’s CHD after thoracotomy. Methods This retrospective data were collected from medical records of children underwent CHD surgery between 2005 and 2017. Results A total of 19,114 children with CHD underwent surgery and 444 children died, with the in-hospital mortality was 2.3%. Complex mixed defect CHD had the highest fatality rate (8.63%), left obstructive lesion CHD had the second highest fatality rate (4.49%), right to left shunt CHD had the third highest mortality rate (3.51%), left to right shunt CHD had the lowest mortality rate (χ2 = 520.3,P < 0.05). The neonatal period has the highest mortality rate (12.17%), followed by infant mortality (2.58%), toddler age mortality (1.16%), and preschool age mortality (0.94%), the school age and adolescent mortality rate was the lowest (χ2 = 529.3,P < 0.05). In addition, the fatality rate in boys was significantly higher than that in girls (2.77% versus 1.62%, χ2 = 26.4, P < 0.05). Conclusions The mortality rate of CHD surgery in children decreased year by year. The younger the age and the more complicated the cyanotic heart disease, the higher the mortality rate may be.
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Affiliation(s)
- Guilang Zheng
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiaxing Wu
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Peiling Chen
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yan Hu
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huiqiong Zhang
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jing Wang
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hanshi Zeng
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xufeng Li
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yueyu Sun
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Gang Xu
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, 106 zhongshan Er Road, Guangzhou, Guangdong, China
| | - Shusheng Wen
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, 106 zhongshan Er Road, Guangzhou, Guangdong, China
| | - Jianzheng Cen
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, 106 zhongshan Er Road, Guangzhou, Guangdong, China
| | - Jimei Chen
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, 106 zhongshan Er Road, Guangzhou, Guangdong, China.
| | - Yuxiong Guo
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Jian Zhuang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (GDPH), Guangdong Academy of Medical Sciences, 106 zhongshan Er Road, Guangzhou, Guangdong, China.
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Talwar S, Arora Y, Gupta SK, Kothari SS, Ramakrishnan S, Saxena A, Choudhary SK. Total Anomalous Pulmonary Venous Connection Beyond the First Decade of Life. World J Pediatr Congenit Heart Surg 2019; 10:185-191. [PMID: 30841831 DOI: 10.1177/2150135118822792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We report our experience with surgery for total anomalous pulmonary venous connection (TAPVC) beyond first decade of life. METHODS Between January 1987 and July 2017, 98 patients ≥ten years underwent TAPVC repair. Their detailed case-records were analyzed. RESULTS Mean age was 19.05 (± 12.8; median 18) years. Anatomic subtypes were supracardiac (n = 62), cardiac (n = 20), and mixed (n = 16). An atrial septal defect (ASD) was present in all. Severe tricuspid valve regurgitation was present in four patients and severe rheumatic mitral regurgitation was present in one. On preoperative cardiac catheterization, mean pulmonary artery pressure was 67 ± 15.6 mm Hg (median 58; range 37-96). Mean pulmonary vascular resistance was 5.6 ± 3.9 Woods units·m2 (median 4.7, range 2.9-11.8). Twenty-five patients had moderate and eight had severe pulmonary arterial hypertension. Right ventricular dysfunction was present in eight patients. At repair, a small ASD was left open in 87 patients while in 11 patients, the ASD was closed using a unidirectional valved patch. Follow-up was available for 90 (92%) patients. There were no late deaths over a mean follow-up of 163 ± 103.98 months (median 163, range 1-362). Eighty-two patients were in NYHA class I and eight were in class II. Right ventricular function normalized in 82 patients while 80 patients had reduction in pulmonary artery pressure. Event-free survival was 94.2% at 5 years, 92.3% at 10 years, and 90% at 20 and 30 years. CONCLUSIONS Outcomes of surgical repair for TAPVC beyond first decade of life are satisfactory. Close follow-up, however, is necessary for possible persistence of pulmonary arterial hypertension.
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Affiliation(s)
- Sachin Talwar
- 1 Departments of Cardiothoracic and Vascular Surgery, Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Yatin Arora
- 1 Departments of Cardiothoracic and Vascular Surgery, Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kumar Gupta
- 2 Departments of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam Sunder Kothari
- 2 Departments of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Anita Saxena
- 2 Departments of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Kumar Choudhary
- 1 Departments of Cardiothoracic and Vascular Surgery, Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Makhija N, Narula J, Keshri VK, Gupta SK, Talwar S. Unidirectional ventricular septal valved patch for repair of late presenting ventricular septal defect with aortopulmonary window. Ann Pediatr Cardiol 2016; 9:90-3. [PMID: 27011704 PMCID: PMC4782481 DOI: 10.4103/0974-2069.171404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Management of long standing left to right shunt lesion resulting in elevated pulmonary vascular resistance (PVR) is challenging. Limited surgical options are further complicated by an unpredictable postoperative period. Unidirectional valve patch (UVP) closure has shown to be useful in cases of the large ventricular septal defect (VSD) who present late. We report a case of large aortopulmonary window coexisting with a large VSD with severe pulmonary artery hypertension and significantly elevated PVR that was managed surgically by closure of the window by sandwich technique and closure of the septal defect with a UVP. This report emphasizes the importance of UVP in the management of such patients.
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Affiliation(s)
- Neeti Makhija
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Jitin Narula
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Kumar Keshri
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kumar Gupta
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sachin Talwar
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
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Talwar S, Keshri VK, Choudhary SK, Gupta SK, Ramakrishnan S, Saxena A, Kothari SS, Juneja R, Kumar G, Airan B. Unidirectional valved patch closure of ventricular septal defects with severe pulmonary arterial hypertension: hemodynamic outcomes. J Thorac Cardiovasc Surg 2014; 148:2570-5. [PMID: 24332111 DOI: 10.1016/j.jtcvs.2013.10.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 09/13/2013] [Accepted: 10/29/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of the present study was to study the midterm hemodynamic outcomes of unidirectional valved patch closure of ventricular septal defects (VSDs) in patients with VSD and pulmonary arterial hypertension (PAH). METHODS From January 2006 to January 2012, 20 patients with VSD with PAH and a pulmonary vascular resistance index >8 Wood units underwent VSD closure with a unidirectional valved patch using the technique previously described by us. Of these, 13 patients agreed to follow-up cardiac catheterization and were studied at a mean follow-up of 34.7 ± 18.6 months (range, 2-56). The mean age of these 13 patients was 8.5 ± 4.4 years (range, 2-19; median, 9), and the mean preoperative systemic saturation was 94.1% ± 3.4% (range, 87-99; median, 95.0) The mean preoperative pulmonary artery systolic pressure was 96.2 ± 13.6 mm Hg (range, 75-115; median, 103.0), and the mean preoperative pulmonary vascular resistance index was 10.0 ± 2.1 Wood units (range, 8.0-15.1; median, 9.3). RESULTS At follow-up cardiac catheterization, the mean systemic saturation had increased to 98.92%. The pulmonary vascular resistance index had decreased significantly to 5.8 ± 2.1 Wood units (P = .02). A significant decrease was seen in the pulmonary artery systolic, diastolic, and mean pressures (P = .000), and none of the patients had severe PAH. No patients died, and all patients were in New York Heart Association class I. CONCLUSIONS Unidirectional valved patch closure of VSD is a promising technique for patients with a large VSD and severe PAH. It had a favorable effect on the immediate, early, and midterm clinical outcomes and hemodynamic parameters.
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Affiliation(s)
- Sachin Talwar
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Vikas Kumar Keshri
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Kumar Choudhary
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kumar Gupta
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | - Anita Saxena
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam Sunder Kothari
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Rajnish Juneja
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Guresh Kumar
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Balram Airan
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Charafeddine L, Arabi M, Alamiddine K, Khatib MI, Bitar F, Halees ZA. Noninvasive Nitric Oxide Therapy in Right Ventricular Systolic Dysfunction Following Arterial Switch Procedure. World J Pediatr Congenit Heart Surg 2014; 5:460-2. [PMID: 24958052 DOI: 10.1177/2150135113519451] [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: 08/08/2013] [Accepted: 12/09/2013] [Indexed: 11/15/2022]
Abstract
Right ventricular dysfunction is uncommon following surgical repair of dextrotransposition of great arteries (d-TGA) by the arterial switch procedure. Inhaled nitric oxide (iNO) is a specific pulmonary vasolidator that has proven successful in treating pulmonary hypertension when delivered via endotracheal tube. We present a five-month-old infant with d-TGA and ventricular septal defect (VSD) who developed pulmonary hypertensive crisis, causing severe right ventricular dysfunction with hemodynamic deterioration at day 6 postsurgical repair by VSD closure and arterial switch. He was successfully treated with iNO via nonrebreather face mask avoiding endotracheal reintubation. This modality should be considered in the management of such infants.
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Affiliation(s)
- Lama Charafeddine
- American University of Beirut Medical Center, Department of Pediatrics and Adolescent Medicine, Beirut, Lebanon
| | - Mariam Arabi
- American University of Beirut Medical Center, Department of Pediatrics and Adolescent Medicine, Beirut, Lebanon
| | - Kawsar Alamiddine
- American University of Beirut Medical Center, Department of Pediatrics and Adolescent Medicine, Beirut, Lebanon
| | - Mohammad Issam Khatib
- American University of Beirut Medical Center, Department of Pediatrics and Adolescent Medicine, Beirut, Lebanon
| | - Fadi Bitar
- American University of Beirut Medical Center, Department of Pediatrics and Adolescent Medicine, Beirut, Lebanon
| | - Zohair Al Halees
- King Faisal Specialist Hospital and Research Center, Heart Center, Riyadh, Saudi Arabia
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Abstract
The arterial switch operation has become a safe operation in many centres. The complexity of the procedure has evolved over the last two decades. Several anatomical features can hardly be considered complex today, namely, normal coronary anatomy, circumflex coming off the right coronary artery, eccentric ostium, and early take-off of an infundibular artery. In addition, as peri-operative mortality becomes very low, the outcomes need to be evaluated on the peri-operative morbidity, late reoperations, and late deaths. The arterial switch operation remains complex in around 20% of the cases, where one or several complexity factors are associated. The complexity of the coronary arteries is a major factor. According to a classification essentially based on the course of the coronary arteries, complex coronaries include: double-looping coronaries, anterior-looping coronaries, intramural coronaries, and single coronary ostium. The most challenging coronary pattern remains the association of a single ostium with intramural course. Other features are equally complex: severe malalignment of the commissures, aortic arch obstruction, multiple ventricular septal defect, Taussig-Bing with subaortic obstruction, double-outlet right ventricle non-committed ventricular septal defect, transposition of the great arteries-intact ventricular septum >3 weeks, transposition of the great arteries-ventricular septal defect with high lung resistances and weight <2.5 kg. Owing to the fact that the risks of arterial switch operation vary according to the experience of the centres, we defined the arterial switch operation complexity based on a subjective approach as proposed by the Aristotle comprehensive score. The recent introduction of a morbidity score will allow to stratify more accurately the outcomes when the peri-operative mortality is very low or nil. The complexity of the coronary patterns tends to be well controlled today. It remains that rare coronary failures and aortic root dilation will occur in the long term, requiring a close follow-up of the most complex patients. Successfully achieving complex arterial switch operation implies a second learning curve.
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Lui RCS, Zhuang J, Lei BF. A better option for patients with TGA/VSD and severe pulmonary hypertension undergoing palliative arterial switch operation. Ann Thorac Surg 2012; 93:692; author reply 692. [PMID: 22269750 DOI: 10.1016/j.athoracsur.2011.06.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Revised: 05/14/2011] [Accepted: 06/14/2011] [Indexed: 12/01/2022]
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Fan H, Zheng Z, Hu S. Reply. Ann Thorac Surg 2012. [DOI: 10.1016/j.athoracsur.2011.09.029] [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: 11/30/2022]
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Talwar S, Choudhary SK, Nair VV, Chauhan S, Kothari SS, Juneja R, Saxena A, Airan B. Arterial switch operation with unidirectional valved patch closure of ventricular septal defect in patients with transposition of great arteries and severe pulmonary hypertension. World J Pediatr Congenit Heart Surg 2012; 3:21-5. [PMID: 23804680 DOI: 10.1177/2150135111421939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE For patients with dextro-transposition of great arteries (d-TGAs), ventricular septal defect (VSD), and severe pulmonary arterial hypertension (PAH), the common surgical options are palliative arterial switch operation (ASO) or palliative atrial switch operation leaving the VSD open. We evaluated the role of ASO with VSD closure using a fenestrated unidirectional valved patch (UVP). METHODS Between July 2009 and February 2011, six patients with TGAs, VSD, and severe PAH (mean age 39.8 ± 47.4 months, median 21, range 8-132 months), weighing 10.7 ± 9.2 kg (median 8.6, range 4.3-29 kg), underwent ASO with VSD closure using our simple technique of UVP. Mean pulmonary artery systolic pressure before the operation was 106 ± 12.7 mm Hg (median 107.5, range 95-126 mm Hg) and pulmonary vascular resistance was 9.5 ± 4.22 units (median 9.5, range 6.6-17.1 Wood units). RESULTS There were no deaths. All patients had a postoperative systemic arterial saturation of more than 95%, although there were frequent episodes of systemic desaturation due to right-to-left shunt across the valved VSD patch (as seen on transesophageal and transthoracic echocardiograms). Mean follow-up was 10 ± 7.6 months (median 7.5, range 1-22 months). At most recent follow-up, all patients had systemic arterial saturation of more than 95% and no right-to-left shunt through the VSD patch. In one patient, the follow-up cardiac catheterization showed a fall in pulmonary artery systolic pressure to 49 mm Hg. CONCLUSION Arterial switch operation with UVP VSD closure is feasible with acceptable early results. It avoids complications of palliative atrial switch (arrhythmia and baffle obstruction) and partially or completely open VSD.
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Affiliation(s)
- Sachin Talwar
- Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India
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Talwar S, Choudhary SK, Airan B. Palliative arterial switch for transposition of the great arteries, ventricular septal defect, and pulmonary vascular obstructive disease. J Thorac Cardiovasc Surg 2011; 141:848; author reply 848-9. [PMID: 21335138 DOI: 10.1016/j.jtcvs.2010.10.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Accepted: 10/27/2010] [Indexed: 11/25/2022]
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Sun T, He L, Sun Z. Damus-Kaye-Stansel biventricular repair for transposition of the great arteries with pulmonary hypertension. J Card Surg 2010; 25:742-4. [PMID: 21039852 DOI: 10.1111/j.1540-8191.2010.01117.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
An 18-year-old female with transposition of great arteries and severe pulmonary hypertension was successfully treated with Damus-Kaye-Stansel biventricular repair. Results of the 12-year follow-up showed satisfactory hemodynamics with the aortic valve staying closed throughout the cardiac cycle and without the pulmonary valve regurgitation.
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Affiliation(s)
- Tucheng Sun
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
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