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Guo J, Ling W, Dang T, Guo S, Ma H, Huang Q, Zeng L, Weng Z, Wu Q. Prenatal transposition of great arteries diagnosis and management: a Chinese single-center study. Front Cardiovasc Med 2024; 11:1341005. [PMID: 38510199 PMCID: PMC10951393 DOI: 10.3389/fcvm.2024.1341005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/26/2024] [Indexed: 03/22/2024] Open
Abstract
Objective This study aimed to assess the diagnostic value of prenatal echocardiography for identifying transposition of the great arteries (TGA) during pregnancy and evaluating the associated outcomes. Methods We conducted a retrospective analysis of 121 prenatally diagnosed patients with TGA at our hospital between January 2012 and September 2022. This analysis included prenatal ultrasound, prenatal screening, clinical management and follow-up procedures. Results Among the 103 fetuses considered in the study, 90 (87.4%) were diagnosed with complete transposition of the great arteries (D-TGA), while 13 (12.6%) exhibited corrected transposition of the great arteries (CC-TGA). Diagnoses were distributed across the trimester, with 8 D-TGA and 2 CC-TGA patients identified in the first trimester, 68 D-TGA patients and 9 CC-TGA patients in the second trimester, and 14 D-TGA and 2 CC-TGA patients referred for diagnosis in the third trimester. Induction of labour was pursued for 76 D-TGA patients (84.4%) and 11 CC-TGA patients (84.6%), and 14 D-TGA patients (15.6%) and 2 CC-TGA patients (15.4%) continued pregnancy until delivery. Among the D-TGA patients, 9 fetuses (10.0%) underwent surgery, two of which were inadvertent fatality, while the remaining seven experienced positive outcomes. Additionally, seven TGA patients received palliative care, leading to four fatalities among D-TGA patients (5.2%), whereas 1 D-TGA patients and 2 CC-TGA patients survived. Conclusion This study underscores the feasibility of achieving an accurate prenatal diagnosis of TGA during early pregnancy. The utility of prenatal ultrasound in the development of personalized perinatal plans and the application of multidisciplinary treatment during delivery are conducive.
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Affiliation(s)
- Jie Guo
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Wen Ling
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Tingting Dang
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shan Guo
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Hong Ma
- Department of Pathology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qiong Huang
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Liqin Zeng
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Zongjie Weng
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qiumei Wu
- Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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Pontailler M, Moiroux-Sahraoui A, Bernheim S, Gaudin R, Houyel L, Bonnet D, Vouhé P, Raisky O. Long-term results after the réparation à l'étage ventriculaire procedure for transposition of the great arteries and double-outlet right ventricle with pulmonary stenosis. Eur J Cardiothorac Surg 2023; 64:ezad409. [PMID: 38150188 DOI: 10.1093/ejcts/ezad409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/09/2023] [Accepted: 12/26/2023] [Indexed: 12/28/2023] Open
Abstract
OBJECTIVES The purpose of this study is to describe the long-term results of the 'réparation à l'étage ventriculaire' (REV) technique for double-outlet right ventricle and transposition of the great arteries (TGA) with pulmonary stenosis (PS). METHODS Between 1980 and 2021, 157 patients underwent a REV procedure (median age and weight: 20.8 months and 7.7 kg). The most frequent anatomical presentation was the association between TGA, ventricular septal defect and PS (n = 116, 73.9%). RESULTS Sixty-seven patients (42.7%) underwent a Rashkind procedure, and 67 patients (42.7%) a prior surgical palliation (including 62 systemic-to-pulmonary artery shunts). Resection of the conal septum and/or ventricular septal defect enlargement was performed in 109 patients (69.4%). Thirteen patients (8.3%) died, including 4 during the first postoperative month and 2 after heart transplant. Overall survival at 40 years was 89.3%. Thirty-seven patients (23.6%) required 68 reinterventions on the right ventricular outflow tract (RVOT), including 49 reoperations, with a median delay of 9 years after the REV (8 months to 27 years). Twenty patients (12.7%) underwent RVOT valvulation (16 surgical and 4 interventional). Freedom from RVOT reintervention and reoperation at 40 years were 60.3% and 62.6%, respectively. Four patients (2.5%) required reoperation for left ventricular outflow tract obstruction, with a median delay of 4.8 years. CONCLUSIONS The REV procedure is a good alternative for TGA and double-outlet right ventricle with PS patients. Only a quarter of the patients required redo surgery on the RVOT. Reoperations for left ventricular outflow tract obstruction are scarce.
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Affiliation(s)
- Margaux Pontailler
- Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital and Université de Paris, Paris, France
| | - Alexander Moiroux-Sahraoui
- Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital and Université de Paris, Paris, France
| | - Ségolène Bernheim
- Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital and Université de Paris, Paris, France
| | - Régis Gaudin
- Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital and Université de Paris, Paris, France
| | - Lucile Houyel
- Department of Pediatric Cardiology, Necker Sick Children Hospital-M3C and Université de Paris, Paris, France
| | - Damien Bonnet
- Department of Pediatric Cardiology, Necker Sick Children Hospital-M3C and Université de Paris, Paris, France
| | - Pascal Vouhé
- Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital and Université de Paris, Paris, France
| | - Olivier Raisky
- Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital and Université de Paris, Paris, France
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Bielecka‐Dabrowa A, Bikiewicz A, Rybak M, Pawliczak F, Lewek J, Banach M, Maciejewski M. Patient after correction Taussig-Bing anomaly with severe neo-aortic regurgitation after sudden cardiac arrest. Clin Case Rep 2021; 9:e05085. [PMID: 34925830 PMCID: PMC8647201 DOI: 10.1002/ccr3.5085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 10/06/2021] [Accepted: 10/26/2021] [Indexed: 11/11/2022] Open
Abstract
The Taussig-Bing anomaly is a rare cyanotic congenital heart defect treated surgically in the early infancy. The preferred repair procedure is an arterial switch operation combined with ventricular septal defect closure. Despite promising long-term functional outcomes and survival benefits, neo-aortic dysfunction and arrhythmias might be relevant complications.
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Affiliation(s)
- Agata Bielecka‐Dabrowa
- Department of Preventive Cardiology and Lipidology, Chair of Nephrology and HypertensionMedical University of LodzLodzPoland
- Polish Mother's Memorial Hospital Research Institute (PMMHRI)Department of Cardiology and Congenital Diseases of AdultsLodzPoland
| | - Agata Bikiewicz
- Polish Mother's Memorial Hospital Research Institute (PMMHRI)Department of Cardiology and Congenital Diseases of AdultsLodzPoland
| | - Marek Rybak
- Polish Mother's Memorial Hospital Research Institute (PMMHRI)Department of Cardiology and Congenital Diseases of AdultsLodzPoland
| | - Filip Pawliczak
- Department of Preventive Cardiology and Lipidology, Chair of Nephrology and HypertensionMedical University of LodzLodzPoland
- Polish Mother's Memorial Hospital Research Institute (PMMHRI)Department of Cardiology and Congenital Diseases of AdultsLodzPoland
| | - Joanna Lewek
- Department of Preventive Cardiology and Lipidology, Chair of Nephrology and HypertensionMedical University of LodzLodzPoland
- Polish Mother's Memorial Hospital Research Institute (PMMHRI)Department of Cardiology and Congenital Diseases of AdultsLodzPoland
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Chair of Nephrology and HypertensionMedical University of LodzLodzPoland
- Polish Mother's Memorial Hospital Research Institute (PMMHRI)Department of Cardiology and Congenital Diseases of AdultsLodzPoland
| | - Marek Maciejewski
- Polish Mother's Memorial Hospital Research Institute (PMMHRI)Department of Cardiology and Congenital Diseases of AdultsLodzPoland
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Kari FA, Uzdenov M, Kroll J, Bohnens H, Stiller B, Bauer U, Kubicki R. Transposition of great arteries with left outflow tract obstruction and non-committed VSD: surgical management and late results. Eur J Cardiothorac Surg 2021; 61:1043-1053. [PMID: 34747469 DOI: 10.1093/ejcts/ezab477] [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: 05/04/2021] [Revised: 09/17/2021] [Accepted: 09/26/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Transposition of the great arteries with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO) is a rare malformation. Our objective was to report on management and results of the cohort with non-committed VSD from a national registry for congenital heart disease. METHODS Multicentre data were screened in the German National Registry for Congenital Heart Defects (Berlin, Germany) for repairs of transposition of the great arteries-VSD-LVOTO. A subgroup of patients with a remote/non-committed VSD was identified. End points included survival, reoperation and a composite of reoperations for LVOTO-/VSD- or baffle-related problem. RESULTS N = 47 patients were identified treated in 14 different national centres between 1984 and 2020. The mean age was 14 (standard deviation 9) months, ranging from 7 days to 9.5 years. Nine patients (19%) were treated as neonates, 21 (45%) as infants and 17 children (36%) beyond the age of 1 year. Survival was >90% (80-100%) at 20 years. Freedom from any reoperation was 30% (10-50%) at 20 years. Freedom from the composite end point was 72% (50-90%) at 20 years. Patients after Rastelli underwent more reoperations compared to those without intraventricular baffle (freedom from reoperation 14% vs 50%, P = 0.1). The rates of the composite end point were similar when comparing Rastelli to other techniques (63% vs 83%, P = 0.32). CONCLUSIONS The Rastelli operation yields robust results in the setting of non-committed VSD. Late results after neonatal arterial switch operation are outstanding. If LVOTO is not resectable and neonatal arterial switch operation suboptimal, interim palliation does not negatively impact outcome, patients can be safely delayed to beyond 1 year of age.
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Affiliation(s)
- Fabian A Kari
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany.,Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Murat Uzdenov
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany.,Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes Kroll
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany.,Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Holger Bohnens
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany.,Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Brigitte Stiller
- Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Ulrike Bauer
- National Registry for Congenital Heart Defects, Berlin, Germany
| | - Rouven Kubicki
- Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg, Bad Krozingen, Germany
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Transposition of the Great Arteries-Are We Doing Better? Correlating Outcome to Change in Renal Function Over 2 Decades of Arterial Switch Operation. Pediatr Crit Care Med 2020; 21:e782-e788. [PMID: 32433443 DOI: 10.1097/pcc.0000000000002387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES It is believed that management of neonates with dextro-transposition of the great arteries is constantly improving. Renal function may play a role in the prognosis of patients after congenital heart surgery. The aim of this study was to describe the outcome of neonates who underwent arterial switch operation during the past 2 decades using renal function as a surrogate marker for morbidity and mortality. DESIGN Retrospective cohort study. SETTING Dedicated cardiac ICU of a university-affiliated pediatric medical center. PATIENTS Infants who underwent arterial switch surgery in 1993-2015. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The cohort included 336 infants who underwent arterial switch operation for dextro-transposition of the great arteries (n = 169, 50%), transposition of the great arteries/ventricular septal defect (n = 133, 40%), or Taussig-Bing anomaly (n = 34, 10%). Between 1993-1998 and 2012-2015, the mean minimal postoperative estimated glomerular filtration rate rose from 30 mL/min/1.73 m to 40 mL/min/1.73 m (p < 0.05), and the proportion of patients with estimated glomerular filtration rate less than 30 mL/min/1.73 m decreased from 56% to 23% (p < 0.05). The daily furosemide dosage decreased from 4 mg/kg/d to 0.5 mg/kg/d (p < 0.05). Urinary output on operative day 0 decreased over time, but urinary output on operative day 2 significantly increased. Maximal lactate levels and time to lactate normalization decreased steadily. Dialysis was performed in only a few patients in the early periods, and in none in the last 6 years. The mean mortality rate of patients with dextro-transposition of the great arteries and transposition of the great arteries/ventricular septal defect decreased to 2.7% in the last 6 years. The odds ratio of a prolonged hospital stay (≥ 28 d) in a patient with estimated glomerular filtration rate less than 30 mL/min/1.73 m was 18.79, and in a patient with transposition of the great arteries/ventricular septal defect, 3.39. The odds ratio of dying after Rashkind atrial septostomy was 4.42. CONCLUSIONS During the past 2 decades, there has been significant improvement in outcome of patients undergoing transposition of the great arteries repair. Renal function was found to be a good prognostic marker of morbidity and mortality.
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Kari FA, Bohnens H, Bierbach B, Bacha EA, Stiller B, Bauer U. Repair of Complex Transposition of Great Arteries: Up to 30 Years of Follow-up. Ann Thorac Surg 2019; 109:555-565. [PMID: 31715151 DOI: 10.1016/j.athoracsur.2019.09.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 08/31/2019] [Accepted: 09/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND To characterize treatment of transposition of great arteries with ventricular septal defect and left ventricular outflow tract obstruction (LVOTO) in Germany and to analyze late outcomes. METHODS German Registry for Congenital Heart Defects data were searched for transposition of great arteries with ventricular septal defect and LVOTO. One hundred thirty-nine patients were treated at 15 institutions between 1968 and 2016. Risk factor analyses were performed for the primary endpoints of death and reoperation/reintervention. RESULTS Follow-up was 88% complete, with a mean follow-up of 16 ± 7 years (median, 15 years [range, 1-48]) and a cumulative follow-up comprising 1739 patient-years. Atrial switches were performed in 15%, Rastelli procedure in 48%, Nikaidoh procedure in 9%, réparation a l'étage ventriculair (REV) in 8%, and arterial switch in 20%. Actuarial survival at 30 years was 86% (range, 83%-90%), with no difference between repairs. Freedom from primary reoperation was 17% (range, 12%-21%) at 30 years. Freedom from reoperation for LVOTO at 30 years was 74% (range, 70%-78%). Recurrent LVOTO was found in 9%, with risk factor diffuse subvalvular LVOTO (odds ratio, 9.8; P = .04). Late freedom from first reoperations other than right ventricle-to-pulmonary artery conduit was 60% (range, 59%-61%), with predictors multiple ventricular septal defect (hazard ratio, 6; P = .03) and Rastelli procedure (hazard ratio, 12; P = .03). Absolute reoperation rates were lowest for REV procedure (16% at a mean of 12 years). CONCLUSIONS Long-term survival is good without detectable differences between operations. Since the early 2000s increasing use of Nikaidoh and REV procedures was obvious, with REV performing particularly well. Surgery-specific and -unspecific reoperations are most common after the Rastelli technique.
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Affiliation(s)
- Fabian A Kari
- Pediatric Cardiac Surgery, New York Presbyterian/Columbia University Medical Center, Morgan Stanley Children's Hospital, New York, New York; Pediatric Cardiac Surgery, Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Holger Bohnens
- Pediatric Cardiac Surgery, Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Benjamin Bierbach
- Cardiac Surgery, German Pediatric Heart Center, St Augustin, Germany
| | - Emile A Bacha
- Pediatric Cardiac Surgery, New York Presbyterian/Columbia University Medical Center, Morgan Stanley Children's Hospital, New York, New York
| | - Brigitte Stiller
- Congenital Heart Defects and Pediatric Cardiology, University Medical Center Freiburg, Freiburg, Germany
| | - Ulrike Bauer
- Competence Network for Congenital Heart Defects, German Registry for Congenital Heart Defects, Berlin, Germany
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Arterial Switch Operation: Operative Approach and Outcomes. Ann Thorac Surg 2019; 107:302-310. [DOI: 10.1016/j.athoracsur.2018.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/26/2018] [Accepted: 06/04/2018] [Indexed: 11/20/2022]
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Olds A, Nakamura Y, Levasseur S, Shah A, Freud L, Chelliah A, Chai P, Quaegebeur J, Bacha E, Kalfa D. Outcomes of Surgical Repair of Complex D-Transposition of the Great Arteries. World J Pediatr Congenit Heart Surg 2018; 9:605-612. [PMID: 30322365 DOI: 10.1177/2150135118789384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND D-transposition of the great arteries (TGA) or TGA-type double outlet right ventricle (DORV) with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO) may be treated with the arterial switch operation (ASO), Rastelli, Réparation à l'Etage Ventriculaire (REV), or Nikaidoh procedures. We evaluated midterm results of these techniques. METHODS We retrospectively reviewed 42 cases of anatomic repair from 2005 to 2014 at our institution for TGA (n = 29) or TGA-type DORV (n = 13) with VSD and LVOTO. We analyzed outcomes (mortality, reoperation, residual/recurrent LVOT peak gradient ≥20 mm Hg, right ventricular outflow tract [RVOT] peak gradient ≥40 mm Hg) and performed a risk analysis. Mean follow-up was 5.77 ± 3.08 years. RESULTS Seventeen (40.5%) patients had an ASO with (n = 4) or without (n = 13) LVOTO resection. The Rastelli, REV, and Nikaidoh procedures were used in 14 (33%), 5 (12%), and 6 (14%) patients, respectively. There were no mortalities or moderate aortic insufficiency at last follow-up. Three (9%) patients developed LVOT gradient ≥20 mm Hg, while nine (21.4%) patients had RVOT obstruction. Reoperations included RVOT/pulmonary artery reoperation (n = 10; 23.8%) and LVOT reoperation (n = 1; 2.5%). Freedom from reoperation was 84% ± 6% and 75% ± 9% at one and three years, respectively, for the entire cohort with no differences between groups by type of operation (log-rank P = .64). The Nikaidoh procedure compared favorably to all other techniques in terms of reoperation (n = 0/6; 0% vs n = 13/36; 36%; P = .08). CONCLUSIONS Midterm outcomes after anatomic repair for TGA or TGA-type DORV with LVOTO and VSD are excellent but vary by surgical technique. The Nikaidoh procedure seems to compare favorably to the other techniques.
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Affiliation(s)
- Anna Olds
- 1 Section of Congenital and Pediatric Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, NY-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA
| | - Yuki Nakamura
- 1 Section of Congenital and Pediatric Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, NY-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA
| | - Stephanie Levasseur
- 2 Division of Pediatric Cardiology, Department of Pediatrics, NY-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA
| | - Amee Shah
- 2 Division of Pediatric Cardiology, Department of Pediatrics, NY-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA
| | - Lindsay Freud
- 2 Division of Pediatric Cardiology, Department of Pediatrics, NY-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA
| | - Anjali Chelliah
- 2 Division of Pediatric Cardiology, Department of Pediatrics, NY-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA
| | - Paul Chai
- 1 Section of Congenital and Pediatric Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, NY-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA
| | - Jan Quaegebeur
- 1 Section of Congenital and Pediatric Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, NY-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA
| | - Emile Bacha
- 1 Section of Congenital and Pediatric Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, NY-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA
| | - David Kalfa
- 1 Section of Congenital and Pediatric Cardiac Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, NY-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA
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Christmann M, Wipf A, Dave H, Quandt D, Niesse O, Deisenberg M, Hersberger M, Kretschmar O, Knirsch W. Risk factor analysis for a complicated postoperative course after neonatal arterial switch operation: The role of troponin T. CONGENIT HEART DIS 2018; 13:594-601. [PMID: 30019379 DOI: 10.1111/chd.12615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/18/2018] [Accepted: 04/19/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To find risk factors for a complicated early postoperative course after arterial switch operation (ASO) in neonates with d-transposition of the great arteries (dTGA). In addition to anatomical and surgical parameters, the predictive value of early postoperative troponin T (TnT) values in correlation to the early postoperative course after ASO is analyzed. METHODS Seventy-nine neonates (57 (72%) male) with simple dTGA treated by ASO between 2009 and 2016 were included in the analysis. A complicated early postoperative course (30 days) was defined by one of the following criteria: (A) moderate to severe cardiac dysfunction without rhythm disturbances, (B) rhythm disturbances causing hemodynamic instability with the need for medical treatment, (C) signs for ischemia in ECG, (D) need for surgical or catheter interventional reinterventions other than diagnostic, or (E) other reasons. RESULTS Forty of 79 patients (51%) showed a complicated early postoperative course after ASO, with 2 patients dying after 13 and 16 days. Patients with a complicated early postoperative course had a longer PICU stay (P < .001), needed longer mechanical ventilator support (P = .001) and longer inotropic support (P = .03), and more reinterventions (surgical or catheter interventional) were necessary (P = .001). Only the presence of a VSD (P = .001) and longer surgery duration (P = .026) were associated to a complicated postoperative course. TnT values only showed a trend toward higher values in patients with a complicated postoperative course (P = .06). A secondary rise in TnT was seen in 10 patients, ranging from 11.6% to 410.2%, of whom 7 could be classified in the complicated postoperative group. CONCLUSIONS The postoperative course after ASO in dTGA neonates is influenced by other cardiac comorbidities like a VSD with the need for surgical treatment, influencing surgery duration. Postoperative higher TnT values reflect a longer and more vulnerable intraoperative course with limited predictive value on the early postoperative course.
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Affiliation(s)
- Martin Christmann
- Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University of Zurich, Zurich, Switzerland
| | - Alexandra Wipf
- Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University of Zurich, Zurich, Switzerland
| | - Hitendu Dave
- Children's Research Center, University of Zurich, Zurich, Switzerland.,Division of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland
| | - Daniel Quandt
- Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University of Zurich, Zurich, Switzerland
| | - Oliver Niesse
- Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University of Zurich, Zurich, Switzerland
| | - Markus Deisenberg
- Children's Research Center, University of Zurich, Zurich, Switzerland.,Department of Intensive Care Medicine and Neonatology, University Children's Hospital, Zurich, Switzerland
| | - Martin Hersberger
- Children's Research Center, University of Zurich, Zurich, Switzerland.,Division of Clinical Chemistry and Biochemistry, University Children's Hospital, Zurich, Switzerland
| | - Oliver Kretschmar
- Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University of Zurich, Zurich, Switzerland
| | - Walter Knirsch
- Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland.,Children's Research Center, University of Zurich, Zurich, Switzerland
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Abstract
BACKGROUND This study evaluates the morbidity, mortality, and cost differences between patients who underwent either a simple or a complex arterial switch operation. METHODS A retrospective study of patients undergoing an arterial switch operation at a single institution was performed. Simple cases were defined as patients with d-transposition of the great arteries with usual coronary anatomy or circumflex artery originating from the right with either intact ventricular septum or ventricular septal defect. Complex cases included all other forms of coronary anatomy, aortic coarctation or arch hypoplasia, and Taussig-Bing anomalies. Costs were acquired using an institutional activity-based accounting system. RESULTS A total of 98 patients were identified, 68 patients in the simple group and 30 in the complex group. The mortality rate was 2% for the simple and 7% for the complex group, p=0.23. Major morbidities including cardiac arrest, extracorporeal membrane oxygenation, a major coronary event, surgical or catheter-based re-intervention, stroke, or permanent pacemaker placement, non-cardiac surgical procedures, mediastinitis, and sepsis did not differ between the simple and complex groups (16 versus 27%, p=0.16). The complex group had increased bleeding requiring re-exploration (0 versus 10%, p=0.04). Hospital and ICU length of stay did not differ. Complex patients had higher overall hospital costs (simple $80,749 versus complex $97,387, p=0.01) and higher postoperative costs (simple $60,192 versus complex $70,132, p=0.02). The operating room and supplies accounted for the majority of the cost difference. CONCLUSION Complex arterial switches can be safely performed with low rates of morbidity and mortality but at an increased cost.
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van Wijk SW, van der Stelt F, ter Heide H, Schoof PH, Doevendans PA, Meijboom FJ, Breur JM. Sudden Death Due to Coronary Artery Lesions Long-term After the Arterial Switch Operation: A Systematic Review. Can J Cardiol 2017; 33:1180-1187. [DOI: 10.1016/j.cjca.2017.02.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 02/27/2017] [Accepted: 02/27/2017] [Indexed: 10/19/2022] Open
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Shim MS, Jun TG, Yang JH, Park PW, Kang IS, Huh J, Song JY. Current expectations of the arterial switch operation in a small volume center: a 20-year, single-center experience. J Cardiothorac Surg 2016; 11:34. [PMID: 26911711 PMCID: PMC4766671 DOI: 10.1186/s13019-016-0428-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 02/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background We reviewed our 20-year experience with arterial switch operation (ASO) for transposition of the great arteries (TGA) or double outlet right ventricle with subpulmonary ventricular septal defect (Taussig-Bing anomaly) to assess the early and long-term outcomes. Methods Between January 1995 and December 2014, 139 consecutive patients who underwent ASO for TGA or Taussig-Bing anomaly were included in this retrospective study. The median age at the operation was 9 (0–485) days, and 97 patients (70 %) underwent ASO less than 2 weeks. The median weight was 3.3 (2.1-10.3) kg. The patients were divided into three groups; simple TGA (n = 78) included patients with TGA with intact ventricular septum, complex TGA (n = 46) included those who had TGA with ventricular septal defect or other anomalies, and Taussig-Bing anomaly (n = 15). Median follow-up duration was 72.5 (0.4-230) months. Results There were 3(2.2 %) in-hospital deaths. One patient (0.7 %) underwent early reoperation due to coronary insufficiency. Late deaths occurred in 3 (2.2 %) of 136 survivors. The Kaplan-Meier’s survival rate was 97.6 ± 1.4 % at 15 years. Twenty-three patients (16.9 %) required 26 reintervention. The freedom from reintervention rates were 82.5 ± 3.7 % at 5 years and 75.8 ± 4.7 % at 10 years, respectively. Median interval between ASO and first reintervention was 22.8 (6.4-89.2) months. The multivariate analysis showed that diagnosis of Taussig-Bing anomaly (hazard ratio, 7.09; P < 0.001) and side by side great artery relationship (hazard ratio, 7.98; P = 0.001) were independent risk factors for reoperation. Five patients (3.9 %) had developed at least moderate neo-aortic regurgitation during the follow-up and one patient underwent reoperation mainly for neo-aortic regurgitation. By multivariate analysis, Taussig-Bing anomaly was the risk factor for at least moderate neo-aortic regurgitation (P = 0.035). Conclusions ASO can be performed with a low risk of early mortality and satisfactory long-term outcomes even in a small volume center. Close long-term surveillance is mandatory to detect structural or hemodynamic changes.
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Affiliation(s)
- Man-shik Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnam-gu, Seoul, 135-710, Korea.
| | - Tae-Gook Jun
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnam-gu, Seoul, 135-710, Korea.
| | - Ji-Hyuk Yang
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnam-gu, Seoul, 135-710, Korea.
| | - Pyo Won Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnam-gu, Seoul, 135-710, Korea.
| | - I Seok Kang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - June Huh
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Jin Young Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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The role of psychology in a pediatric outpatient cardiology setting: preliminary results from a new clinical program. J Clin Psychol Med Settings 2015; 21:337-46. [PMID: 25217969 DOI: 10.1007/s10880-014-9404-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of this study was to provide a descriptive analysis of a new clinical program integrating psychology services within a pediatric outpatient cardiology clinic. Patients with congenital heart disease (CHD) (n = 79) were referred for psychological services by their pediatric cardiologist. Parents completed the child behavior checklist, and the pediatric quality of life inventory generic core scales (PedsQL parent report). Teachers completed the teacher report form. Reasons for referral included: emotional problems (29%); attention problems (25%); learning problems (22%); behavior problems (16%); and developmental delay (8%). Parents and teachers reported higher rates of behavior problems and lower quality of life scores than the general population. Psychological evaluation suggested that incorporating a psychologist within a pediatric cardiology clinic may be beneficial for children with CHD in order to optimize their psychosocial functioning. Practice implications for implementing psychology services within a pediatric outpatient cardiology program are discussed.
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Reconstruction of a new pulmonary artery in arterial switch operation. World J Pediatr 2015; 11:177-80. [PMID: 24668236 DOI: 10.1007/s12519-014-0473-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study was undertaken to evaluate the new method for the reconstruction of the pulmonary artery in arterial switch operation (ASO). METHODS A total of 108 consecutive infants with congenital heart disease were treated with ASO in our department between January 2004 and June 2012. The new pulmonary arterial root was reconstructed with a fresh autologuos pericardium which was clipped pants-like with continuous mattress suture of 6-0 Prolene thread. Patients were reexamined consecutively at 3 and 6 months and 1, 2 and 6 years after discharge. The pulmonary arterial blood velocity was measured by continuous Doppler during systole. The pulmonary flow of healthy children of same age was also measured in the control group. Simplified Bernoulli formula was used to calculate the pressure gradient via the pulmonary artery for determining whether there was pulmonary stenosis. RESULTS In this series, 96 infants survived after the surgery and 88 were followed up with a mean peirod of (22±4) months. No pulmonary stenosis was detected with the simplified Bernoulli formula. CONCLUSION No pulmonary stenosis was detected with the simplified Bernoulli formula.
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Arterioplasty for Right Ventricular Outflow Tract Obstruction After Arterial Switch Is a Durable Procedure. Ann Thorac Surg 2015; 100:122-7; discussion 127-8. [PMID: 25921259 DOI: 10.1016/j.athoracsur.2015.02.086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 02/08/2015] [Accepted: 02/12/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Right ventricular outflow tract obstruction (RVOT) is the most common late complication requiring intervention after arterial switch operation (ASO). The durability of surgical management of this complication has not been well established. METHODS We retrospectively reviewed the charts of 38 consecutive patients who underwent RVOT reconstruction after ASO at our institution between 2004 and 2013. During the same time period, 223 consecutive patients underwent ASO for transposition of the great arteries at our institution. Thirty-five (16%) of the 223 patients developed RVOT obstruction, and 3 additional patients who had ASO done elsewhere presented to us with RVOT obstruction. Patient characteristics, site of stenosis, type of intervention, and outcomes were analyzed. Data are presented as median with interquartile ranges. RESULTS The time interval between ASO and echocardiographic diagnosis of significant RVOT obstruction was 12.5 (3 to 23.7) months. After echocardiographic diagnosis, 33 (87%) children underwent cardiac catheterization. Obstruction involved the supravalvar main pulmonary artery (PA) in 21 (64%), branch PA in 14 (42%), pulmonary valve in 4 (12%), and sub-valvar area in 1 (3%). Ten of 33 patients who underwent catheterization had attempted percutaneous intervention, with 4 (40%) demonstrating significant response. Surgical intervention was performed at a median of 4 months in responders compared with 2.3 months in non-responders. Surgical repair included main PA plasty (36), extended to 1 or both branch PAs (26), or crossed the RVOT annulus (7). Surgical morbidity was 13% and there was no hospital or late mortality. At last follow-up, 41.2 months (21.4 to 81) after RVOT reconstruction, all patients had New York Heart Association grade 0 or 1 symptoms, and RV pressure was a median 36% of systemic pressure. Five (13%) patients underwent catheterization 26 months after surgery, with 2 requiring dilation at site of arterioplasty and 3 requiring distal branch PA intervention. One patient required reoperation for main PA stenosis. Freedom from re-intervention after surgery is 89%, 86%, and 86% at 2, 3, and 5 years, respectively. CONCLUSIONS Surgical management of RVOT obstruction after ASO is an effective and durable intervention in the intermediate term. Our results serve as a benchmark for expected outcomes in this disease process.
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Hermsen JL, Chen JM. Surgical Considerations in d-Transposition of the Great Arteries. Semin Cardiothorac Vasc Anesth 2015; 19:223-32. [PMID: 25918115 DOI: 10.1177/1089253215584195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The surgical treatment for d-transposition has evolved dramatically since the inception of cardiac surgery in the 1950s. Today, the arterial switch operation is employed almost exclusively in the management of this disease unless significant left ventricular outflow obstruction is present. Surgical options for these patents are reviewed and an in-depth technical discussion of arterial switch for d-transposition of the great arteries/intact ventricular septum follows.
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Schwarz F, Blaschczok HC, Sinzobahamvya N, Sata S, Korn F, Weber A, Asfour B, Hraška V. The Taussig-Bing anomaly: long-term results†. Eur J Cardiothorac Surg 2013; 44:821-7. [DOI: 10.1093/ejcts/ezt148] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hong SJ, Choi HJ, Kim YH, Hyun MC, Lee SB, Cho JY. Clinical features and surgical outcomes of complete transposition of the great arteries. KOREAN JOURNAL OF PEDIATRICS 2012; 55:377-82. [PMID: 23133484 PMCID: PMC3488613 DOI: 10.3345/kjp.2012.55.10.377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 03/08/2012] [Accepted: 07/09/2012] [Indexed: 11/27/2022]
Abstract
Purpose This single-center study aimed to assess the clinical features and surgical approaches and outcomes of complete transposition of the great arteries (TGA). Methods TGA patients who had undergone surgical correction at the Kyungpook National University Hospital from January 2000 to December 2010, were retrospectively evaluated for patient characteristics, clinical manifestation, preoperative management, intraoperative findings, postoperative progress, and follow-up status. Results Twenty-eight patients (17 boys and 11 girls, mean age=10.6±21.5 days) were included and were categorized as follows: group I, TGA with intact ventricular septum (n=13); group II, TGA with ventricular septal defect (VSD, n=12); and group III, TGA/VSD with pulmonary stenosis (n=3). Group I underwent the most intensive preoperative management (balloon atrial septostomy and prostaglandin E1 medication). Group II showed the highest incidence of heart failure (P<0.05). Usual and unusual coronary anatomy patterns were observed in 20 (71%) and 8 patients, respectively. Arterial and half-turned truncal switch operations were performed in 25 and 3 patients (Group III), respectively. Postoperative complications included cardiac arrhythmias (8 patients), central nervous system complications (3 patients), acute renal failure (1 patient), infections (3 patients), and cardiac tamponade (1 patient), and no statistically significant difference was observed between the groups. Group II showed the mildest aortic regurgitation on follow-up echocardiograms (P<0.05). One patient underwent reoperation, and 1 died. The overall mortality rate was 4%. Conclusion Our study showed favorable results in all the groups and no significant difference in postoperative complication, reoperation, and mortality among the groups. However, our results were inadequate to evaluate the risk factors for reoperation and mortality owing to the small number of patients and short follow-up duration.
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Affiliation(s)
- Suk Jin Hong
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
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Mechanisms of Pulmonary Hypertension Related to Ventricular Septal Defect in Congenital Heart Disease. Ann Thorac Surg 2011; 92:2215-20. [DOI: 10.1016/j.athoracsur.2011.07.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Revised: 07/12/2011] [Accepted: 07/19/2011] [Indexed: 11/23/2022]
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20
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Reoperative Techniques for Complications After Arterial Switch. Ann Thorac Surg 2011; 92:1747-54; discussion 1754-5. [DOI: 10.1016/j.athoracsur.2011.04.102] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 04/14/2011] [Accepted: 04/18/2011] [Indexed: 11/17/2022]
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21
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García-Hernández JA, Montero-Valladares C, Martínez-López AI, Gil-Fournier M, Praena-Fernández JM, Cano-Franco J, Loscertales-Abril M. [Prognostic evaluation of arterial switch in the transposition of great arteries]. An Pediatr (Barc) 2010; 74:174-81. [PMID: 21190907 DOI: 10.1016/j.anpedi.2010.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Revised: 08/06/2010] [Accepted: 09/19/2010] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The arterial switch is the procedure of choice for transposition of great arteries, with or without ventricular septal defect. The aim of this study was to identify risk factors for hospital mortality. METHODS The study included 121 children between January 1994 and June 2008. Of these, 80 (66%) were diagnosed with intact ventricular septum, and 41 (34%) with ventricular septal defect. Variables were collected pre-operatively, during surgery, and postoperatively. RESULTS The mean age was 11 [8 to 16] days and a mean weight of 3.5 [3.0 to 3.7] kg. A ventricular septal defect was closed in 11 children (9.1%). A total of 81.8% had a normal coronary pattern. There was delayed closure of the chest in 38 patients (31.4%). The hospital mortality was 11.6%, decreasing over the past 5 years to 2.1%. The weight, abnormal coronary pattern, time of cardiopulmonary bypass, mean arterial pressure at admission, pulmonary dead space, and delayed closure of the chest, were risk factors of mortality. The model that best predicts death, consists of the mean arterial pressure at admission, and delayed closure of the chest. CONCLUSIONS The reduction in extracorporeal circulation time and the use of delayed closure of the chest, have helped to reduce mortality. The abnormal coronary pattern remains a risk factor for mortality. In children with delayed closure of the chest, a mean arterial pressure at admission ≥ 47.5 mmHg is a goal to achieve.
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Affiliation(s)
- J A García-Hernández
- Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Infantil Universitario Virgen del Rocío, Seville, Spain.
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Vargo P, Mavroudis C, Stewart RD, Backer CL. Late Complications Following the Arterial Switch Operation. World J Pediatr Congenit Heart Surg 2010; 2:37-42. [PMID: 23804931 DOI: 10.1177/2150135110386976] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The arterial switch operation has been the principal treatment for transposition of the great arteries and its variants for the last 25 years. Early mortality has decreased significantly over time, but long-term complications include pulmonary artery stenosis, coronary artery obstruction, neoaortic valvar insufficiency, arrhythmia, and aortic arch obstruction. This article provides an overview of the history, anatomic patterns, surgical results, and possible operative solutions discussed in the literature for patients with transposition of the great arteries who undergo arterial switch operations that result in late complications. Published journal articles were identified through PubMed literature search. The authors selected 72 articles for analysis. It is concluded that modifications can be made to the arterial switch operation in an effort to meet the challenges presented by late complications.
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Affiliation(s)
- Patrick Vargo
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Constantine Mavroudis
- Cleveland Clinic Children’s Hospital, Department of Congenital Heart Surgery, Cleveland, OH, USA
| | - Robert D. Stewart
- Cleveland Clinic Children’s Hospital, Department of Congenital Heart Surgery, Cleveland, OH, USA
| | - Carl L. Backer
- Children’s Memorial Hospital, Northwestern University Feinberg School of Medicine, Division of Cardiovascular-Thoracic Surgery, Department of Surgery, Chicago, IL, USA
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Walter EMD, Huebler M, Alexi-Meshkishvili V, Sill B, Berger F, Hetzer R. Fate of the Aortic Valve Following the Arterial Switch Operation. J Card Surg 2010; 25:730-6. [DOI: 10.1111/j.1540-8191.2010.01144.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Liu YL, Hu SS, Shen XD, Li SJ, Wang X, Yan J, Wu X, Huang JB, Kong B. Midterm Results of Arterial Switch Operation in Older Patients With Severe Pulmonary Hypertension. Ann Thorac Surg 2010; 90:848-55. [DOI: 10.1016/j.athoracsur.2010.03.114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 03/30/2010] [Accepted: 03/30/2010] [Indexed: 11/17/2022]
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Weyand K, Haun C, Blaschczok H, Goetz-Toussaint N, Photiadis J, Sinzobahamvya N, Asfour B, Hraška V. Surgical Treatment of Transposition of Great Arteries With Ventricular Septal Defect and Left Ventricular Outflow Tract Obstruction. World J Pediatr Congenit Heart Surg 2010; 1:163-9. [DOI: 10.1177/2150135110371810] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our purpose was to evaluate our single-center experience with the treatment of transposition of the great arteries (TGA) with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO). Between 1992 and 2009, 42 patients were operated on. Twenty-three patients underwent the Rastelli operation, 8 patients underwent arterial switch operation (ASO) with associated LVOTO procedures, 4 patients underwent the réparation à l’étage ventriculaire (REV) procedure, 3 patients underwent the Bex/Nikaidoh (BN) procedure, and the Fontan operation was performed in 4 patients. The median age at final operation was 20.7 months (range, 0.3-234). The overall survival rate was 97% (1 early death), with a median follow-up of 8.2 years. There were no differences in survival among the surgical groups. Event-free survival was 100%, 84%, 59%, and 24% at 1, 5, 10, and 15 years of follow-up, respectively, with it being worse in the Rastelli group ( P < .0348). The last echocardiography showed good function of the systemic ventricle in all patients; LVOTO pressure gradient greater than 30 mm Hg was observed in 2 patients (5%), and right ventricular outflow tract obstruction (RVOTO) pressure gradient >30 mm Hg was observed in 12 patients (31%). All patients are in sinus rhythm, and 74% of them are without medication. All surgical approaches are safe and show excellent midterm functional outcome. ASO is the best option if the LVOTO is resectable. Intraventricular rerouting (Rastelli or REV) is the method of choice in the majority of patients, but Rastelli has a significant reintervention rate. The BN operation has the potential to minimize utilization of the Fontan operation, which was used in the past if the intracardiac anatomy was unfavorable.
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Affiliation(s)
- Katrin Weyand
- German Pediatric Heart Center, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
| | - Christoph Haun
- German Pediatric Heart Center, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
| | - Hedwiga Blaschczok
- German Pediatric Heart Center, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
| | | | - Joachim Photiadis
- German Pediatric Heart Center, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
| | | | - Boulos Asfour
- German Pediatric Heart Center, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
| | - Viktor Hraška
- German Pediatric Heart Center, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
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Kim CY, Kim WH, Kwak JG, Jang WS, Lee CH, Kim DJ, Lim C, Chang WI. Surgical management of left ventricular outflow tract obstruction after biventricular repair of double outlet right ventricle. J Korean Med Sci 2010; 25:374-9. [PMID: 20191035 PMCID: PMC2826730 DOI: 10.3346/jkms.2010.25.3.374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 05/14/2009] [Indexed: 12/04/2022] Open
Abstract
Regardless of the preoperative morphology and the type of operation, left ventricular outflow tract obstruction (LVOTO) after biventricular repair of double outlet right ventricle (DORV) may develop. This report presents our 10-yr experience with surgical management of LVOTO after biventricular repair of DORV. Between 1996 and 2006, 15 patients underwent reoperation for subaortic stenosis after biventricular repair of DORV. The mean age at biventricular repair was 23.3+/-18.3 months (1.1-64.2). Biventricular repairs included tunnel constructions from the left ventricle to the aorta in 14 cases and an arterial switch operation in one. The mean left ventricle-to-aorta peak pressure gradient was 54.0+/-37.7 mmHg (15-140) after a mean follow-up of 9.5+/-6.3 yr. We performed extended septoplasty in nine patients and fibromuscular resection in six. There were no early or late mortality. There was one heart block and one aortic valve injury after an extended septoplasty, and two and one after a fibromuscular resection. No patient required reoperation for recurrent subaortic stenosis. The mean pressure gradient was 11.2+/-11.4 mmHg (0-34) after a mean follow-up of 5.6+/-2.7 yr. Extended septoplasty is a safe and effective method for the treatment of subaortic stenosis, especially in cases with a long-tunnel shaped LVOTO.
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Affiliation(s)
- Chang Young Kim
- Department of Thoracic and Cardiovascular Surgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Buchon, Korea
| | - Woo-Sung Jang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Chang-Ha Lee
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Buchon, Korea
| | - Dong Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Woo Ik Chang
- Department of Thoracic and Cardiovascular Surgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
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Arterial Switch for Transposition of the Great Vessels and Taussig-Bing Anomaly After Six Months of Age. Ann Thorac Surg 2009; 88:1948-51. [DOI: 10.1016/j.athoracsur.2009.08.051] [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: 06/13/2009] [Revised: 08/19/2009] [Accepted: 08/20/2009] [Indexed: 11/22/2022]
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Angeli E, Raisky O, Bonnet D, Sidi D, Vouhé PR. Late reoperations after neonatal arterial switch operation for transposition of the great arteries. Eur J Cardiothorac Surg 2008; 34:32-6. [DOI: 10.1016/j.ejcts.2008.04.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 04/03/2008] [Accepted: 04/07/2008] [Indexed: 11/25/2022] Open
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Lacour-Gayet F. Intracardiac repair of double outlet right ventricle. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2008; 11:39-43. [PMID: 18396223 DOI: 10.1053/j.pcsu.2007.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Intracardiac repair of double outlet right ventricle (DORV) remains controversial. DORV is a particular mode of ventriculo-arterial connection and not a specific congenital heart disease. It can exhibit a wide spectrum of anatomic and physiologic variations. This heterogeneity has naturally led to controversies over the anatomical definition, classification schemes, and the techniques for surgical repair. From a surgical standpoint, the functional classification that was adopted together by the Society of Thoracic Surgeons (STS), The European Association of Cardio-Thoracic Surgery (EACTS) and the Association of the European Pediatric Cardiologists (AEPC), provides useful information to understand the anatomical variations and the choice of the surgical technique. The lesions that remain a surgical challenge are those where "200% of the great vessels" arise from the right ventricle. Namely: DORV-nc-VSD and DORV-AVSD-heterotaxy. Both of these lesions have traditionally been indications for single-ventricle palliation. In our series, there was one death in 15 of these challenging patients (6.7% mortality) following bi-ventricular repair. Two patients required a one and a half repair. Long-term results of biventricular repair of complex DORV are not yet available. These data would be crucial to validate the intracardiac repair technique."
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Affiliation(s)
- F Lacour-Gayet
- The Children's Hospital Heart Institute, Denver, CO 80218, USA.
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Ullmann MV, Gorenflo M, Bolenz C, Sebening C, Goetze M, Arnold R, Ulmer HE, Hagl S. Late results after extended pulmonary artery reconstruction in the arterial switch operation. Ann Thorac Surg 2007; 81:2259-66. [PMID: 16731163 DOI: 10.1016/j.athoracsur.2006.01.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2005] [Revised: 01/05/2006] [Accepted: 01/05/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pulmonary artery stenosis remains the most frequent late complication and cause of reintervention after the arterial switch operation for transposition of the great arteries. We investigated the influence of an extended pericardial patch augmentation of the neopulmonary root and pulmonary artery on late pulmonary artery stenosis development. METHODS Augmentation of the neopulmonary root and pulmonary artery was achieved by reconstructing the posterior wall using a large glutaraldehyde-treated autologous pericardial patch. Reviewed were regular follow-up echocardiograms from 58 out of 87 patients undergoing the arterial switch operation who presented a follow-up period of at least 5 years. An actual follow-up echocardiographic evaluation focusing on the maximal instantaneous transpulmonary continuous-wave (cw)-Doppler gradient was performed, followed by cardiac catheterization when indicated (peak cw-Doppler gradient > 40 mm Hg). RESULTS Follow-up was 8.9 [5 to 15] years. There was no reintervention due to residual pulmonary artery stenosis. Actual Doppler examination revealed a transpulmonary peak gradient of 19.5 [0 to 56] mm Hg, compared with 20 [0 to 60] mm Hg at discharge. Forty-three patients (74.1%) had no or only trivial pulmonary artery stenosis (pressure gradient < 25 mm Hg), 14 patients (24.2%) had mild stenosis (25 to 49 mm Hg), and 1 patient (1.7%) had moderate stenosis (50 to 79 mm Hg). CONCLUSIONS Compared with the majority of literature data, we could demonstrate a low incidence of late pulmonary artery stenosis after the arterial switch operation by employing an extended pericardial patch reconstruction technique with augmentation of the neopulmonary root and pulmonary artery.
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Affiliation(s)
- Michael V Ullmann
- Department of Cardiac Surgery, University Medical Center, University of Heidelberg, Heidelberg, Germany.
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Prandstetter C, Hofer A, Lechner E, Mair R, Sames-Dolzer E, Tulzer G. Early and mid-term outcome of the arterial switch operation in 114 consecutive patients. Clin Res Cardiol 2007; 96:723-9. [PMID: 17676353 DOI: 10.1007/s00392-007-0546-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2007] [Accepted: 04/30/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND The arterial switch operation (ASO) has become the treatment of choice in patients with simple or complex transposition of the great arteries (TGA). The purpose of this study was to assess early and mid-term outcome after ASO in a single centre. PATIENTS AND METHODS Between 1995 and December 2005, 114 consecutive patients underwent an ASO at our institution, performed by one single surgeon. Patients charts, surgical reports and echocardiograms were retrospectively reviewed. Patients were analyzed in 3 different groups: Group I consisted of 77 neonates with TGA and intact ventricular septum, group II of 13 patients with TGA and ventricular septal defect which had to be closed surgically and group III of 24 patients with various forms of TGA in a complex setting. The patient's median weight was 3.23 kg (1.65-8.30). Twenty-five neonates were born preterm, 18 were diagnosed prenatally. Median follow-up time was 20.7 months (0.3-128.6). RESULTS The thirty day mortality was 1.75% (2/114), late mortality 0.88% (1/112) accounting for an overall mortality of 2.63%. There was only one early coronary event and so far no late events. Ten of 111 survivors required reoperation, all but 1 from group III. Prevalence of supravalvular pulmonary stenosis was 4.7%. Freedom from reoperation at 5 years of follow-up time was 87.5%. One patient required permanent pacing, no other late arrhythmias occurred. In our series the only risk factor for increased mortality and morbidity was a body weight of less than 2500 g at the time of operation. No better outcome could be demonstrated in the prenatally diagnosed patients. CONCLUSION The ASO can be performed safely and with low mortality and morbidity even in patients with complex TGA. Follow-up of these patients is required to detect residual problems like supravalvular pulmonary stenosis, coronary problems, arrhythmias and aortic valve dysfunction.
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Affiliation(s)
- C Prandstetter
- Department of Peadiatric Cardiology, Children's Heart Centre Linz, Krankenhausstrasse 26-30, 4020 Linz, Austria
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Brosig CL, Mussatto KA, Kuhn EM, Tweddell JS. Psychosocial outcomes for preschool children and families after surgery for complex congenital heart disease. Pediatr Cardiol 2007; 28:255-62. [PMID: 17486393 DOI: 10.1007/s00246-006-0013-4] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 12/21/2006] [Indexed: 11/29/2022]
Abstract
The purpose of the current study was to assess the psychosocial outcomes of preschool-aged survivors (ages 3-6 years) of hypoplastic left heart syndrome (HLHS; n=13) and transposition of the great arteries (TGA; n=13). Parents completed the following measures: Pediatric Quality of Life Inventory, Impact on the Family Scale, Parenting Stress Index, Parent Behavior Checklist, and Child Behavior Checklist. Quality of life scores did not differ from those of healthy controls. Parents of children with HLHS reported more negative impact of the child's illness on the family and more parenting stress than parents of children with TGA. Parents of both groups of children were more permissive in their parenting style than parents of healthy controls. Children with HLHS had higher rates of attention and externalizing behavior problems than children with TGA. The results highlight the need for practitioners working with these children and families to ask about parental stress, family functioning, and behavioral expectations for the child in the context of routine medical/cardiac follow-up.
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Affiliation(s)
- C L Brosig
- Department of Pediatrics, Medical College of Wisconsin, and Children's Hospital of Wisconsin, Herma Heart Center, Milwaukee, WI 53226, USA.
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Roofthooft MTR, Bergman KA, Waterbolk TW, Ebels T, Bartelds B, Berger RMF. Persistent Pulmonary Hypertension of the Newborn With Transposition of the Great Arteries. Ann Thorac Surg 2007; 83:1446-50. [PMID: 17383355 DOI: 10.1016/j.athoracsur.2006.11.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Revised: 10/30/2006] [Accepted: 11/01/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND Persistent pulmonary hypertension of the newborn (PPHN) in patients with transposition of the great arteries (TGA) is reported to be a high-risk and often therapy-resistant condition, associated with a high mortality. However, data on its incidence and prognosis are scarce and originate mostly from the era before introduction of inhaled nitric oxide (iNO) therapy for PPHN. METHODS This is a retrospective study of consecutive newborns with TGA, admitted to a tertiary cardiac and neonatal intensive unit over a 10-year period. In this period, iNO therapy was available. RESULTS Fourteen out of 112 patients with TGA (12.5%) presented with associated PPHN. The PPHN occurred more frequently in patients with TGA and intact ventricular septum (IVS) compared with those with TGA and ventricular septal defect (13 out of 83 patients versus one out of 29 patients, respectively; p = 0.06, Fisher exact test). Of those newborns, six presented with severe PPHN, whereas eight presented with mild-to-moderate PPHN. Despite currently available treatment modalities, including iNO, four out of 14 patients died before corrective surgical procedures were considered to be an option (TGA/PPHN preoperative mortality 28.6%). These included three out of six patients (50%) with severe PPHN and one out of eight (12.5%) with mild-to-moderate PPHN. CONCLUSIONS The combination of TGA with PPHN is a serious and often fatal condition. It may jeopardize the usually favorable outcome of newborns with TGA. Despite the introduction of iNO therapy, the combination of TGA and PPHN remains a condition with unacceptable high mortality (in our series). Additional treatment strategies need to be investigated.
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Affiliation(s)
- Marcus T R Roofthooft
- Department of Paediatric Cardiology, Beatrix Children's Hospital, Groningen, The Netherlands.
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Brosig CL, Mussatto KA, Kuhn EM, Tweddell JS. Neurodevelopmental outcome in preschool survivors of complex congenital heart disease: implications for clinical practice. J Pediatr Health Care 2007; 21:3-12. [PMID: 17198894 DOI: 10.1016/j.pedhc.2006.03.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Revised: 03/22/2006] [Accepted: 03/23/2006] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The purpose of this study was to describe the neurodevelopmental outcome of preschool survivors of Hypoplastic Left Heart Syndrome (HLHS) and Transposition of the Great Arteries (TGA) in the modern surgical era. METHODS A cross-sectional design was used to evaluate 26 children (13 HLHS, 13 TGA), ages 3.5 to 6 years, at a Midwestern children's hospital. Measures included McCarthy Scales of Children's Abilities, Woodcock Johnson III Tests of Achievement, Developmental Test of Visual-Motor Integration, Receptive One-Word Vocabulary Test, Expressive One-Word Vocabulary Test, and Child Behavior Checklist. RESULTS Although intelligence quotient scores fell within the average range for both groups (TGA=110.5 vs. HLHS=97), the difference between groups was clinically meaningful (effect size= .79). The HLHS group showed more problems than did the TGA group with visual-motor skills, expressive language, attention, and externalizing behavior. DISCUSSION Results suggest that even in the modern surgical era, regular developmental screening for these patients is critical. Pediatric nurse practitioners play an important role in educating parents about the potential developmental risks to these children.
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Affiliation(s)
- Cheryl L Brosig
- Medical College of Wisconsin, Department of Pediatrics, Milwaukee,Wisconsin, USA
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Jouannic JM, Gavard L, Fermont L, Le Bidois J, Parat S, Vouhé PR, Dumez Y, Sidi D, Bonnet D. Sensitivity and Specificity of Prenatal Features of Physiological Shunts to Predict Neonatal Clinical Status in Transposition of the Great Arteries. Circulation 2004; 110:1743-6. [PMID: 15364811 DOI: 10.1161/01.cir.0000144141.18560.cf] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although prenatal diagnosis of transposition of the great arteries (TGA) reduces neonatal mortality, the preoperative course can be complicated in infants with a restrictive foramen ovale (FO) or a ductus arteriosus (DA) constriction. We sought to determine the specificity and sensitivity of prenatal features of physiological shunts in predicting postnatal clinical status in prenatally diagnosed TGA in babies delivered in a tertiary care center providing all facilities for neonatal urgent care. METHODS AND RESULTS The outcomes of 130 fetuses with TGA were reviewed over a period of 5.5 years. Restriction of the FO and/or constriction of the DA could be analyzed in 119/130 fetuses at 36+/-2.7 weeks of gestation. Twenty-four out of 119 had at least 1 abnormal shunt (23 FO, 5 DA, and 4 both). Thirteen of 130 neonates had profound hypoxemia (PaO2<25 mm Hg) and metabolic acidosis (pH <7.15) in the first 30 minutes and required immediate balloon atrioseptostomy. Two who had abnormal FO and DA died despite aggressive resuscitation. The specificity and sensitivity of the fetal echo in predicting neonatal emergency were 84% and 54%, respectively. The specificity and sensitivity of a combination of restrictive FO and DA constriction were 100% and 31%, respectively. CONCLUSIONS Restriction of the FO and/or of the DA has a high specificity to predict the need for emergency neonatal care in fetuses with TGA, but the sensitivity is too low to detect all high-risk fetuses. Exceptional procedures should be considered for fetuses that have a combination of restrictive FO and DA constriction.
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Wetter J, Sinzobahamvya N, Blaschczok HC, Cho MY, Brecher AM, Grävinghoff LM, Urban AE. Results of arterial switch operation for primary total correction of the Taussig-Bing anomaly. Ann Thorac Surg 2004; 77:41-6; discussion 47. [PMID: 14726031 DOI: 10.1016/s0003-4975(03)01134-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study evaluates the results of the arterial switch operation for early total repair of double-outlet right ventricle with subpulmonary ventricular septal defect (the Taussig-Bing heart). METHODS From 1986 through April 2003, 27 patients with Taussig-Bing anomaly underwent arterial switch operation. Twenty patients were neonates (n = 11) or infants younger than 3 months (n = 9). Obstruction of aortic arch (n = 19) or subaortic right ventricular outflow tract obstruction (n = 20) and unusual coronary artery patterns (n = 19) were common. Total correction as a single procedure was performed in 21 patients. Events are depicted by Kaplan-Meier curves. RESULTS There was 1 patient hospital death at 2 months after repair. One patient died late that was not cardiac related. Survival was 92% +/- 6% at 8 months and remained constant thereafter. Four patients underwent reoperation (1 for residual aortic arch obstruction and 3 for subvalvular and valvular pulmonary stenosis). Freedom from reoperation decreased to stabilize at 83% +/- 8% after 2 years. The risk to have right ventricular outflow tract obstruction develop was 33% +/- 10% at 1 year, increasing slowly and leveling out at 57% +/- 12% at year 5 and thereafter. Statistical analysis revealed no significant risk factor for death or need for reoperation. CONCLUSIONS The Taussig-Bing anomaly should be corrected in the neonatal period or in early infancy by arterial switch operation, closure of the ventricular septal defect, and simultaneous correction of associated cardiovascular anomalies as a one-stage procedure. Right ventricular outflow tract obstruction often complicates the postoperative course and is the main cause for reintervention.
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Affiliation(s)
- Jutta Wetter
- Department of Paediatric Cardiothoracic Surgery, Sankt Augustin, Germany
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