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Ohuchi H, Kawata M, Uemura H, Akagi T, Yao A, Senzaki H, Kasahara S, Ichikawa H, Motoki H, Syoda M, Sugiyama H, Tsutsui H, Inai K, Suzuki T, Sakamoto K, Tatebe S, Ishizu T, Shiina Y, Tateno S, Miyazaki A, Toh N, Sakamoto I, Izumi C, Mizuno Y, Kato A, Sagawa K, Ochiai R, Ichida F, Kimura T, Matsuda H, Niwa K. JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair. Circ J 2022; 86:1591-1690. [DOI: 10.1253/circj.cj-22-0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Ohuchi
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, National Cerebral and Cardiovascular Center
| | - Masaaki Kawata
- Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children’s Medical Center Tochigi
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Atsushi Yao
- Division for Health Service Promotion, University of Tokyo
| | - Hideaki Senzaki
- Department of Pediatrics, International University of Health and Welfare
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Morio Syoda
- Department of Cardiology, Tokyo Women’s Medical University
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University
| | - Takaaki Suzuki
- Department of Pediatric Cardiac Surgery, Saitama Medical University
| | | | - Syunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Yumi Shiina
- Cardiovascular Center, St. Luke’s International Hospital
| | - Shigeru Tateno
- Department of Pediatrics, Chiba Kaihin Municipal Hospital
| | - Aya Miyazaki
- Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiko Mizuno
- Faculty of Nursing, Tokyo University of Information Sciences
| | - Atsuko Kato
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children’s Hospital
| | - Ryota Ochiai
- Department of Adult Nursing, Yokohama City University
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health and Welfare
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Koichiro Niwa
- Department of Cardiology, St. Luke’s International Hospital
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Kupferschmid JP, Turek JW, Hughes GC, Austin EH, Alsoufi B, Smith JM, Scholl FG, Rankin JS, Badhwar V, Chen JM, Nuri MA, Romano JC, Ohye RG, Si MS. Early Outcomes of Patients Undergoing Neoaortic Valve Repair Incorporating Geometric Ring Annuloplasty. World J Pediatr Congenit Heart Surg 2022; 13:304-309. [PMID: 35446224 DOI: 10.1177/21501351221079523] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES During congenital heart surgery, the pulmonary valve and root may be placed into the systemic position, yielding a "neoaortic" valve. With the stress of systemic pressure, the pulmonary roots can dilate, creating aneurysms and/or neoaortic insufficiency (neoAI). This report analyzes the early outcomes of patients undergoing neoaortic valve repair incorporating geometric ring annuloplasty. METHODS Twenty-one patients underwent intended repair at six centers and formed the study cohort. Thirteen had previous Ross procedures, five had arterial switch operations, and three Fontan physiology. Average age was 21.7 ± 12.8 years (mean ± SD), 80% were male, and 11 (55%) had symptomatic heart failure. Preoperative neoAI Grade was 3.1 ± 1.1, and annular diameter was 30.7 ± 6.5 mm. RESULTS Valve repair was accomplished in 20/21, using geometric annuloplasty rings and leaflet plication (n = 13) and/or nodular release (n = 7). Fourteen had neoaortic aneurysm replacement (13 with root remodeling). Two underwent bicuspid valve repair. Six had pulmonary conduit changes, one insertion of an artificial Nodulus Arantius, and one resection of a subaortic membrane. Ring size averaged 21.9 ± 2.3 mm, and aortic clamp time was 171 ± 54 minutes. No operative mortality or major morbidity occurred, and postoperative hospitalization was 4.3 ± 1.4 days. At discharge, neoAI grade was 0.2 ± 0.4 (P < .0001), and valve mean gradient was ≤20 mm Hg. At average 18.0 ± 9.1 months of follow-up, all patients were asymptomatic with stable valve function. CONCLUSIONS Neoaortic aneurysms and neoAI are occasionally seen late following Ross, arterial switch, or Fontan procedures. Neoaortic valve repair using geometric ring annuloplasty, leaflet reconstruction, and root remodeling provides a patient-specific approach with favorable early outcomes.
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Affiliation(s)
| | | | - G Chad Hughes
- 22957Duke University Medical Center, Durham, NC, USA
| | | | | | | | - Frank G Scholl
- Joe Dimaggio 24931Children's Hospital, Hollywood, FL, USA
| | | | | | - Jonathan M Chen
- 24931Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Muhammad A Nuri
- 24931Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Vricella LA, El-Zein C, Hibino N, Rausa J, Roberson D, Ilbawi MN. Technical Modifications that Might Improve Long-Term Outcome of the Ross Procedure in Children. Ann Thorac Surg 2021; 112:1997-2004. [PMID: 33794157 DOI: 10.1016/j.athoracsur.2021.03.047] [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] [Received: 01/09/2021] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Failure of the pulmonary autograft (PVA) following the Ross procedure (RP) has discouraged its widespread use and led to modifications or alternatives to the procedure. We sought to analyze whether certain technical modifications could improve results of the RP in children. METHODS Sixty-nine patients (median age 12 years, range 0.25 to 17.9) underwent the RP between 01/1996 and 12/2018. Concomitant Konno procedure was performed on 20/69 (29%). Prior interventions included balloon valvuloplasty in 30/69 (44%), and/or surgical valvuloplasty in 39/69 (57%). Technical modifications included utilizing the native aortic root for external annuloplasty, implanting the autograft using uniplanar horizontal sutures through the aortic wall, normalizing the sinotubular junction and wrapping the native root remnant around the PVA. RESULTS Operative mortality was 1/69 (1.5%), with no late death. No patient had neoaortic valvar stenosis and 7/68 (10%) had mild regurgitation on discharge echocardiogram. At latest follow-up (median 9.4 years, range 0.4 - 21.3) there was no significant change in the latest follow up Z scores of annulus, sinus or sinotubular junction diameters when compared to those at discharge. Three patients (4.4%) required late autograft replacement, two PVA repair, and two resection of pseudoaneurysm. Actuarial freedom from PVA replacement was 87% at 20 yrs. Freedom from right ventricular outflow tract catheter reintervention or reoperation was 83% and 80% respectively. CONCLUSIONS Technical modifications of the RP used in this cohort might successfully prolong the life of the PVA without compromising its growth, an important advantage in pediatric patients.
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Affiliation(s)
- Luca A Vricella
- The Heart Institute for Children, Advocate Children's Hospital, Oak Lawn, IL; Department of Surgery, University of Chicago Medicine, Oak Lawn, IL.
| | - Chawki El-Zein
- The Heart Institute for Children, Advocate Children's Hospital, Oak Lawn, IL
| | - Narutushi Hibino
- The Heart Institute for Children, Advocate Children's Hospital, Oak Lawn, IL; Department of Surgery, University of Chicago Medicine, Oak Lawn, IL
| | - Jacqueline Rausa
- The Heart Institute for Children, Advocate Children's Hospital, Oak Lawn, IL
| | - David Roberson
- The Heart Institute for Children, Advocate Children's Hospital, Oak Lawn, IL
| | - Michel N Ilbawi
- The Heart Institute for Children, Advocate Children's Hospital, Oak Lawn, IL
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Vera F, Sarria E, Ortiz A, Ruiz E. Cirugía de la transposición de las grandes arterias en periodo neonatal. CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2020.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Predictors of neo-aortic valve regurgitation in the long term after arterial switch operation. Heart Vessels 2020; 36:693-703. [PMID: 33245489 DOI: 10.1007/s00380-020-01729-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
Although arterial switch operations (ASOs) have been performed globally to repair d-transposition of the great arteries (d-TGA) in neonates and infants, few studies have been reported regarding the influence of the hemodynamics of patients with d-TGA who have undergone ASO on the development of neo-aortic valve regurgitation (AR). We aimed to investigate the relationship between the hemodynamics and development of AR after ASO in patients with d-TGA by catheter evaluation. This observational study screened 114 consecutive patients who underwent ASO for d-TGA or Taussig-Bing anomaly and who subsequently underwent catheter evaluations in our institution. We reviewed their records for the past 20 years and collected their first catheterization data post-ASO in early childhood. Thirty-six post-ASO patients who underwent catheter evaluations in both the early surgical and long-term phases were finally analyzed. Patients were divided into the following groups according to the presence of significant AR in the long-term phase: the AR group (n = 9 with AR ≥ grade II by the Sellers classification) and the non-AR group (n = 27 with AR < grade II). In the long-term phase, the diastolic blood pressure was significantly lower and the ascending aortic diameter was significantly larger in the AR group than in the non-AR group (p = 0.004 and p = 0.006, respectively). The systolic blood pressure (SBP) and pulse pressure (PP) were similar in both groups. Meanwhile, in the early surgical phase, SBP and PP were significantly higher in the AR group than in the non-AR group (p = 0.029 and p = 0.002, respectively). The receiver operating characteristic curve for late AR showed that the area under the curve for SBP and PP in the early surgical phase were 0.746 and 0.853, respectively. Even though sensitivity analysis was performed, SBP or PP greater than the cutoff value in the early surgical phase was identified as predictors for late AR. Our results suggested that high SBP or PP in the early surgical phase could influence the development of AR in the long term after ASO.
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Cha SG, Baek JS, Yu JJ, Kim YH, Kwon BS, Choi ES, Park CS, Yun TJ. Growth Pattern of the Neo-Aorta after Arterial Switch Operation during Childhood. Korean Circ J 2020; 51:83-93. [PMID: 33164353 PMCID: PMC7779819 DOI: 10.4070/kcj.2020.0249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/15/2020] [Accepted: 09/24/2020] [Indexed: 12/01/2022] Open
Abstract
Background and Objectives Neo-aortic root dilatation (ARD) and annular dilatation (AAD) tend to develop after arterial switch operation (ASO). However, the trend of neo-aortic growth has not been well established. This paper aims to identify this trend, its associated factors, and predictors of neo-aortic dilatation after ASO. Methods We analyzed the growth trend of the neo-aortic root, annulus, and sinotubular junction (STJ) z-scores using random coefficients model and the risk factors affecting neo-aortic dilatation in 163 patients who underwent ASO from 2006 to 2015. Results Among 163 patients, 41 had a ventricular septal defect, and 11 had Taussig-Bing (TB) anomaly. The median follow-up duration was 6.61 years. The increased in the neo-aortic root z-score was different between the trapdoor and non-trapdoor coronary artery transfer techniques (0.149/year, p<0.001 vs. 0.311/year, p<0.001). Moreover, the neo-aortic annulus and STJ z-score significantly increased over time after ASO (0.067/year, p<0.001; 0.309/year, p<0.001). Pulmonary artery banding (PAB) was rather a negative affecting factor. The probabilities of freedom from ARD, AAD, and neo-aortic STJ dilatation at 10 years after ASO were 33.4%, 53.9%, and 65.4%. Neo- aortic regurgitation within 1 year was the predictor of ARD, AAD, and neo-aortic STJ dilatation. TB anomaly, PAB, and native pulmonary sinus z-score were other predictors for ARD. Conclusion The growth of neo-aortic root, annulus, and STJ after ASO was greater than somatic growth during childhood. The coronary artery transfer technique affected the growth pattern of the neo-aortic root.
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Affiliation(s)
- Seul Gi Cha
- Division of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Suk Baek
- Division of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Jeong Jin Yu
- Division of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hwue Kim
- Division of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bo Sang Kwon
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Seok Choi
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chun Soo Park
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Jin Yun
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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van der Palen RL, van der Zee C, Vink AS, Knobbe I, Jurgens SJ, van Leeuwen E, Bax CJ, du Marchie Sarvaas GJ, Blom NA, Haak MC, Bilardo CM, Clur SB. Transposition of the great arteries: Fetal pulmonary valve growth and postoperative neo-aortic root dilatation. Prenat Diagn 2019; 39:1054-1063. [PMID: 31351016 PMCID: PMC6900129 DOI: 10.1002/pd.5539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/05/2019] [Accepted: 07/16/2019] [Indexed: 12/04/2022]
Abstract
AbstractObjectivesDocumentation of semilunar valve growth in fetal transposition of the great arteries (TGA) and the relationship between neo‐aortic root (NAoR) dilatation, a cause for postoperative reinterventions after the arterial switch operation (ASO), and pulmonary valve (PV) annulus dimensions prenatally.MethodsThis retrospective multicenter observational study included TGA fetuses suitable for ASO. Semilunar valve annuli pre‐ASO and NAoR diameters (post‐ASO) were measured. Trends in annulus diameters were analyzed using a linear mixed‐effects model and compared with normal values. Prenatal semilunar valve Z‐scores were correlated with NAoR diameters post‐ASO.ResultsWe included 137 TGA fetuses (35.8% with significant ventricular septal defects [VSDs]). One hundred twenty‐one underwent ASO. Fetal TGA‐PV diameters were significantly larger than control aortic valve (AoV) and PV annuli from 23 and 27 weeks, respectively, especially when a VSD was present. Fetal TGA‐AoV annuli were significantly larger than control AoV and PV annuli from 26 and 30 weeks, respectively.Z‐scores of fetal TGA‐PV and NAoR diameter at last follow‐up correlated significantly (P < .001 at 26‐30 wk).ConclusionFetal TGA semilunar valve annuli are larger than control annuli, especially when there is a significant VSD. Factors besides postoperative hemodynamics, including fetal anatomy, PV Z‐score, prenatal flow, connective tissue properties, and genetics, may influence the risk for late reintervention in these fetuses.
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Affiliation(s)
- Roel L.F. van der Palen
- Division of Pediatric Cardiology, Department of PediatricsLeiden University Medical CentreLeidenThe Netherlands
| | - Carlijn van der Zee
- Department of Pediatric CardiologyEmma Children's Hospital, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Arja S. Vink
- Department of Pediatric CardiologyEmma Children's Hospital, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
- Heart Centre, Department of CardiologyAcademic Medical Centre, Amsterdam UMCAmsterdamThe Netherlands
| | - Ingmar Knobbe
- Department of Pediatric CardiologyAmsterdam UMC, Free UniversityAmsterdamThe Netherlands
| | - Sean J. Jurgens
- Department of Pediatric CardiologyEmma Children's Hospital, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Elizabeth van Leeuwen
- Department of Prenatal DiagnosisAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Caroline J. Bax
- Department of Prenatal DiagnosisAmsterdam UMC, Free UniversityAmsterdamThe Netherlands
| | | | - Nico A. Blom
- Division of Pediatric Cardiology, Department of PediatricsLeiden University Medical CentreLeidenThe Netherlands
- Department of Pediatric CardiologyEmma Children's Hospital, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Monique C. Haak
- Department of Prenatal DiagnosisLeiden University Medical CentreLeidenThe Netherlands
| | - Caterina M. Bilardo
- Department of Prenatal DiagnosisUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Sally‐Ann B. Clur
- Department of Pediatric CardiologyEmma Children's Hospital, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
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van der Palen RLF, van der Bom T, Dekker A, Tsonaka R, van Geloven N, Kuipers IM, Konings TC, Rammeloo LAJ, Ten Harkel ADJ, Jongbloed MRM, Koolbergen DR, Mulder BJM, Hazekamp MG, Blom NA. Progression of aortic root dilatation and aortic valve regurgitation after the arterial switch operation. Heart 2019; 105:1732-1740. [PMID: 31292191 PMCID: PMC6855793 DOI: 10.1136/heartjnl-2019-315157] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/03/2019] [Accepted: 05/14/2019] [Indexed: 11/29/2022] Open
Abstract
Objective To study neo-aortic growth and the evolution of neo-aortic valve regurgitation (AR) in patients with transposition of the great arteries (TGA) after arterial switch operation (ASO) from newborn to adulthood and to identify patients at risk. Methods Neo-aortic dimensions (annulus/root/sinotubular junction) and neo-aortic valve regurgitation were assessed serially in 345 patients with TGA who underwent ASO between 1977 and 2015. Linear mixed-effect models were used to assess increase of neo-aortic dimensions over time and to identify risk factors for dilatation. Risk factor analysis for AR by using time-dependent Cox regression models. Results After a rapid increase in the first year after ASO and proportional growth in childhood, neo-aortic dimensions continue to increase in adulthood without stabilisation. Annual diameter increase in adulthood was 0.39±0.06, 0.63±0.09 and 0.54±0.11 mm for, respectively, neo-aortic annulus, root and sinotubular junction, all significantly exceeding normal growth. AR continues to develop over time: freedom from AR ≥moderate during the first 25 years post-ASO was 69%. Risk factors for root dilatation were complex TGA anatomy (TGA-ventricular septal defect (VSD), double outlet right ventricle with subpulmonary VSD) and male gender. Risk factors for AR ≥moderate were: complex TGA anatomy and neo-aortic growth. Per millimetre increase in aortic root dimension, there was a 9% increase in the hazard of AR ≥moderate. Bicuspid pulmonary valve did not relate to the presence of root dilatation or AR. Conclusion After ASO, neo-aortic dilatation proceeds beyond childhood and is associated with an increase in AR incidence over time. Careful follow-up of the neo-aortic valve and root function is mandatory, especially in males and in patients with complex TGA anatomy.
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Affiliation(s)
- Roel L F van der Palen
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Teun van der Bom
- Department of Cardiology, Amsterdam UMC, Univ of Amsterdam, Amsterdam, The Netherlands
| | - Annika Dekker
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Roula Tsonaka
- Department of Biomedical Data Sciences, Section Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Nan van Geloven
- Department of Biomedical Data Sciences, Section Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Irene M Kuipers
- Division of Pediatric Cardiology, Department of Pediatrics, Amsterdam UMC, Univ of Amsterdam, Amsterdam, The Netherlands
| | - Thelma C Konings
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lukas A J Rammeloo
- Division of Pediatric Cardiology, Department of Pediatrics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Arend D J Ten Harkel
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique R M Jongbloed
- Department of Anatomy&Embryology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dave R Koolbergen
- Department of Cardiothoracic Surgery, Amsterdam UMC, Univ of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Barbara J M Mulder
- Department of Cardiology, Amsterdam UMC, Univ of Amsterdam, Amsterdam, The Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.,Division of Pediatric Cardiology, Department of Pediatrics, Amsterdam UMC, Univ of Amsterdam, Amsterdam, The Netherlands
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Long-Term Growth of the Neoaortic Root After Arterial Switch Operation. Ann Thorac Surg 2019; 107:1203-1211. [DOI: 10.1016/j.athoracsur.2018.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 07/26/2018] [Accepted: 09/12/2018] [Indexed: 11/17/2022]
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Baker-Smith CM, Carlson K, Ettedgui J, Tsuda T, Jayakumar KA, Park M, Tede N, Uzark K, Fleishman C, Connuck D, Likes M, Penny DJ. Development of quality metrics for ambulatory pediatric cardiology: Transposition of the great arteries after arterial switch operation. CONGENIT HEART DIS 2017; 13:52-58. [PMID: 28971577 DOI: 10.1111/chd.12540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/13/2017] [Accepted: 09/10/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To develop quality metrics (QMs) for the ambulatory care of patients with transposition of the great arteries following arterial switch operation (TGA/ASO). DESIGN Under the auspices of the American College of Cardiology Adult Congenital and Pediatric Cardiology (ACPC) Steering committee, the TGA/ASO team generated candidate QMs related to TGA/ASO ambulatory care. Candidate QMs were submitted to the ACPC Steering Committee and were reviewed for validity and feasibility using individual expert panel member scoring according to the RAND-UCLA methodology. QMs were then made available for review by the entire ACC ACPC during an "open comment period." Final approval of each QM was provided by a vote of the ACC ACPC Council. PATIENTS Patients with TGA who had undergone an ASO were included. Patients with complex transposition were excluded. RESULTS Twelve candidate QMs were generated. Seven metrics passed the RAND-UCLA process. Four passed the "open comment period" and were ultimately approved by the Council. These included: (1) at least 1 echocardiogram performed during the first year of life reporting on the function, aortic dimension, degree of neoaortic valve insufficiency, the patency of the systemic and pulmonary outflows, the patency of the branch pulmonary arteries and coronary arteries, (2) neurodevelopmental (ND) assessment after ASO; (3) lipid profile by age 11 years; and (4) documentation of a transition of care plan to an adult congenital heart disease (CHD) provider by 18 years of age. CONCLUSIONS Application of the RAND-UCLA methodology and linkage of this methodology to the ACPC approval process led to successful generation of 4 QMs relevant to the care of TGA/ASO pediatric patients in the ambulatory setting. These metrics have now been incorporated into the ACPC Quality Network providing guidance for the care of TGA/ASO patients across 30 CHD centers.
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Affiliation(s)
- Carissa M Baker-Smith
- Department of Pediatrics/Division of Pediatric Cardiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Karina Carlson
- Department of Pediatrics/Division of Pediatric Cardiology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Jose Ettedgui
- Department of Pediatrics/Division of Pediatric Cardiology, University of Florida, Jacksonville, Florida, USA
| | - Takeshi Tsuda
- Department of Pediatrics/Division of Pediatric Cardiology, Alfred I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - K Anitha Jayakumar
- Department of Pediatrics/Division of Pediatric Cardiology, University of Virginia, Charlottesville, Virginia, USA
| | - Matthew Park
- Pediatrix Medical Group - Northwest Children's Heart Care, Tacoma, Washington, USA
| | - Nikola Tede
- California Pacific Medical Center, San Francisco, California, USA
| | - Karen Uzark
- Department of Pediatrics/Division of Pediatric Cardiology, University of Michigan Congenital Heart Center, Ann Arbor, Missouri, USA
| | - Craig Fleishman
- Department of Pediatrics/Division of Pediatric Cardiology, The Heart Center at Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - David Connuck
- Janet Weis Children's Hospital, Danville, Pennsylvania, USA
| | - Maggie Likes
- Department of Pediatrics/Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Daniel J Penny
- Department of Pediatrics/Division of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
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Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum. Cardiol Young 2017; 27:530-569. [PMID: 28249633 DOI: 10.1017/s1047951117000014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Chowdhury D, Gurvitz M, Marelli A, Anderson J, Baker-Smith C, Diab KA, Edwards TC, Hougen T, Jedeikin R, Johnson JN, Karpawich P, Lai W, Lu JC, Mitchell S, Newburger JW, Penny DJ, Portman MA, Satou G, Teitel D, Villafane J, Williams R, Jenkins K, Williams R, Jenkins K, Gurvitz M, Marelli A, Campbell R, Chowdhury D, Jedeikin R, Behera S, Hokanson J, Lu J, Kakavand B, Boris J, Cardis B, Bansal M, Anderson J, Schultz A, O'Connor M, Vinocur JM, Halnon N, Johnson J, Barrett C, Graham E, Krawczeski C, Franklin W, McGovern J, Hattendorf B, Teitel D, Cotts T, Davidson A, Harahsheh A, Johnson W, Jone PN, Sutton N, Tani L, Dahdah N, Portman M, Mensch D, Newburger J, Hougen T, Cross R, Diab K, Karpawich P, Lai W, Peuster M, Schiff R, Saarel E, Satou G, Serwer G, Villafane J, Edwards T, Penny D, Carlson K, Jayakumar KA, Park M, Tede N, Uzark K, Baker Smith C, Fleishman C, Connuck D, Ettedgui J, Likes M, Tsuda T. Development of Quality Metrics in Ambulatory Pediatric Cardiology. J Am Coll Cardiol 2017; 69:541-555. [DOI: 10.1016/j.jacc.2016.11.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/25/2016] [Accepted: 11/18/2016] [Indexed: 11/24/2022]
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Sarris GE, Balmer C, Bonou P, Comas JV, da Cruz E, Chiara LD, Di Donato RM, Fragata J, Jokinen TE, Kirvassilis G, Lytrivi I, Milojevic M, Sharland G, Siepe M, Stein J, Büchel EV, Vouhé PR. Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum. Eur J Cardiothorac Surg 2017; 51:e1-e32. [DOI: 10.1093/ejcts/ezw360] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Öner T, Özdemir R, Güven B, Yılmazer MM, Doksöz Ö, Meşe T, Tavlı V. Evaluation of myocardial function in pediatric patients with transposition of great arteries after arterial switch operation. Anatol J Cardiol 2016; 16:55-61. [PMID: 26467364 PMCID: PMC5336706 DOI: 10.5152/akd.2015.5692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE An arterial switch operation converts the left ventricle (LV) into the systemic ventricle, replacing the right ventricle (RV), which is the systemic ventricle during the prenatal period. The procedure is performed in patients with arterial transposition and those in whom a coronary reimplantation procedure is performed. Therefore, the adaptation of LV and RV to the arterial switch operations is an interesting issue. This study aimed to evaluate systolic and diastolic functions in the LV and RV myocardium using echocardiography in pediatric patients with transposed great arteries after an arterial switch operation. METHODS This observational case control study included 28 patients and 20 gender-and age-matched healthy controls. A group study was performed using patients who were followed for at least 6 months after the operation and who visited the pediatric cardiology outpatient between October 2009 and May 2011. Systolic and diastolic parameters, LV and RV myocardial performance index (MPI) values, and left atrium (LA) volume index were assessed in both groups. RESULTS The LV MPI and tricuspid valve (TV) E/Ea ratio measured using pulsed-wave Doppler were higher in the patient group than in the control group. The TV E/A ratio and late velocity of lateral mitral annulus (Aa) and systolic velocity (Sa)-early diastolic velocity (Ea)-late velocity (Aa) of the septal mitral annulus and systolic velocity (Sa)-early diastolic velocity (Ea)-late velocity (Aa) of the lateral tricuspid annulus were lower in the patient group than in the control group. CONCLUSION Considering the present study's findings obtained during short-to mid-term follow-up, the RV tissue Doppler flows and the LV MPI were found impaired.
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Affiliation(s)
- Taliha Öner
- Department of Pediatric Cardiology, İzmir Dr. Behçet Uz Children Hospital; İzmir-Turkey.
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Raja SG, Shauq A, Kaarne M. Outcomes after Arterial Switch Operation for Simple Transposition. Asian Cardiovasc Thorac Ann 2016; 13:190-8. [PMID: 15905355 DOI: 10.1177/021849230501300222] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Without intervention, babies born with transposed great arteries (TGA) are doomed to a rapid death. Jatene and coworkers deserve the credit for performing the first successful arterial switch operation (ASO) in a patient with TGA and ventricular septal defect (VSD) in 1975. Since then ASO has become the procedure of choice in most medical centers. This review article summarizes the historical aspects of arterial switch operation and assesses this procedure's outcomes.
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Affiliation(s)
- Shahzad G Raja
- Department of Pediatric Cardiac Surgery, Alder Hey Hospital, Liverpool, United Kingdom.
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Sievers HH, Scharfschwerdt M, Putman LM. In vitroevaluation of physiological spiral anastomoses for the arterial switch operation in simple transposition of the great arteries: a first step towards a surgical alternative? Interact Cardiovasc Thorac Surg 2015; 21:157-62. [DOI: 10.1093/icvts/ivv114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/13/2015] [Indexed: 11/13/2022] Open
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Impact of initial shunt type on cardiac size and function in children with single right ventricle anomalies before the Fontan procedure: the single ventricle reconstruction extension trial. J Am Coll Cardiol 2014; 64:2026-35. [PMID: 25440099 DOI: 10.1016/j.jacc.2014.08.033] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 07/06/2014] [Accepted: 08/13/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND In children with single right ventricular (RV) anomalies, changes in RV size and function may be influenced by shunt type chosen at the time of the Norwood procedure. OBJECTIVES The study sought to identify shunt-related differences in echocardiographic findings at 14 months and ≤6 months pre-Fontan in survivors of the Norwood procedure. METHODS We compared 2-dimensional and Doppler echocardiographic indices of RV size and function, neo-aortic and tricuspid valve annulus dimensions and function, and aortic size and patency at 14.1 ± 1.2 months and 33.6 ± 9.6 months in subjects randomized to a Norwood procedure using either the modified Blalock-Taussig shunt (MBTS) or right ventricle to pulmonary artery shunt (RVPAS). RESULTS Acceptable echocardiograms were available at both time points in 240 subjects (114 MBTS, 126 RVPAS). At 14 months, all indices were similar between shunt groups. From the 14-month to pre-Fontan echocardiogram, the MBTS group had stable indexed RV volumes and ejection fraction, while the RVPAS group had increased RV end-systolic volume (p = 0.004) and decreased right ventricular ejection fraction (RVEF) (p = 0.004). From 14 months to pre-Fontan, the treatment groups were similar with respect to decline in indexed neo-aortic valve area, >mild neo-aortic valve regurgitation (<5% at each time), indexed tricuspid valve area, and ≥moderate tricuspid valve regurgitation (<20% at each time). CONCLUSIONS Initial Norwood shunt type influences pre-Fontan RV remodeling during the second and third years of life in survivors with single RV anomalies, with greater RVEF deterioration after RVPAS. Encouragingly, other indices of RV function remain stable before Fontan regardless of shunt type. (Comparison of Two Types of Shunts in Infants with Single Ventricle Defect Undergoing Staged Reconstruction-Pediatric Heart Network; NCT00115934).
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Abstract
PURPOSE OF REVIEW The objective of this review is to summarize the recent data pertaining to aortic dilatation in congenital heart disease (CHD) and to discuss the current understanding of the pathophysiology and management of this disease. RECENT FINDINGS Aortic dilatation is a common finding in CHD. However, acute aortic complications appear to be relatively rare. Multiple factors predispose this population to aortic dilatation, including underlying genetics, cellular-based mechanisms, and abnormalities in aortic mechanics and valve morphology. SUMMARY Although aortic dilatation is common in CHD, data about adverse long-term outcomes are limited. Optimal disease-specific management strategies have yet to be developed, and further research is needed to guide care in this population.
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van der Bom T, van der Palen RLF, Bouma BJ, van Veldhuisen SL, Vliegen HW, Konings TC, Zwinderman AH, Blom NA, Koolbergen DR, Hazekamp MG, Mulder BJM. Persistent neo-aortic growth during adulthood in patients after an arterial switch operation. Heart 2014; 100:1360-5. [PMID: 24837983 DOI: 10.1136/heartjnl-2014-305702] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE After the arterial switch operation (ASO), disproportional neo-aortic growth during childhood has been reported. Even though it has been suggested neo-aortic dilation will stabilise in adulthood, data are lacking. The aim of this study was to assess the change in neo-aortic dimensions, prevalence of neo-aortic dilation >40 mm and long-term outcome in adults who underwent ASO in childhood. METHODS All 116 ASO patients operated in a tertiary referral centre and born before 1995 were included. Of these, 83 (72%) survived to adulthood (>17 years) and six were lost to follow-up. Neo-aortic measurements performed in adulthood were collected from available echocardiographic, cardiovascular magnetic resonance and CT images. The time trend was analysed using a mixed model, adjusted for imaging modality. RESULTS Clinical data with at least one measurement of the neo-aortic diameter were available in 77 (93%) adult patients and serial measurements in 65 (78%). At baseline (median age 18.1 years), mean neo-aortic diameter was 36±5 mm. Mean neo-aortic growth was 0.31 mm/year (p<0.001 compared with normal value 0.08 mm/year) and was linear over time. Freedom from neo-aortic dilation beyond a diameter of 40 mm was 23% at 28 years of age. During a mean clinical follow-up in adulthood of 7.2 years (IQR 4.0 to 10.1), 3 (4%) patients underwent neo-aortic replacement. No other neo-aortic complications occurred. CONCLUSIONS In early adulthood, neo-aortic growth was on average linear and did not stabilise over time.
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Affiliation(s)
- Teun van der Bom
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands The Netherlands Heart Institute, Utrecht, The Netherlands
| | - Roel L F van der Palen
- Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Berto J Bouma
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Hubert W Vliegen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Thelma C Konings
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
| | - Nico A Blom
- Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dave R Koolbergen
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Barbara J M Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands The Netherlands Heart Institute, Utrecht, The Netherlands
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Novel SMAD3 Mutation in a Patient with Hypoplastic Left Heart Syndrome with Significant Aortic Aneurysm. Case Rep Genet 2014; 2014:591516. [PMID: 24711937 PMCID: PMC3970455 DOI: 10.1155/2014/591516] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/06/2014] [Indexed: 11/24/2022] Open
Abstract
Aneurysms-osteoarthritis syndrome (AOS) caused by haploinsufficiency of SMAD3 is a recently described cause of syndromic familial thoracic aortic aneurysm and dissection (TAAD). We identified a novel SMAD3 mutation in a patient with hypoplastic left heart syndrome (HLHS) who developed progressive aortic aneurysm requiring surgical replacement of the neoaortic root, ascending aorta, and proximal aortic arch. Family screening for the mutation revealed that his father, who has vascular and skeletal features of AOS, and his brother, who is asymptomatic, also have the pathogenic mutation. This is the first case report of a SMAD3 mutation in a patient with hypoplastic left heart syndrome. This case highlights the importance of genetic testing for known causes of aneurysm in patients with congenital heart disease who develop aneurysmal disease as it may significantly impact the management of those patients and their family members.
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Great vessel root and artery dimensions in transposition of the great arteries repaired with atrial switch operation. Pediatr Cardiol 2014; 35:457-62. [PMID: 24096720 DOI: 10.1007/s00246-013-0800-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 09/14/2013] [Indexed: 10/26/2022]
Abstract
To describe great-vessel dimensions in patients with D-loop transposition of the great arteries (TGA) who have undergone atrial switch operation (ATSO). Patients who have undergone arterial switch operation for TGA have a high incidence of dilation of the neoaortic root. The incidence and degree of great artery dilation in patients who have undergone ATSO for TGA has not previously been described. A retrospective database review identified patients with TGA and intact ventricular septum who underwent ATSO at <1 year of age with cardiac magnetic resonance (CMR) within the previous 5 years (n = 39). A control group of patients referred for CMR with normal findings was identified for comparison (n = 40). Measurements of the annulus, root, sinotubular junction, and great vessels were performed, and interobserver/intraobserver variability was assessed. Median age of subjects at ATSO was 3 months (range 1-12) with median age at CMR of 29 years (range 18-40). For aortic measurements, mean z scores (± SDs) for patients relative to body surface area (BSA)-adjusted normal controls were as follows: annulus 1.41 (0.80), root 2.04 (1.48), sinotubular junction 2.16 (1.26), and great vessel 1.86 (1.53). For pulmonary measurements, similar values were as follows: annulus 1.82 (1.42), root 3.25 (2.01), sinotubular junction 2.47 (1.79), and great vessel 3.96 (3.08). In all cases, the p value was <0.001, and no confidence interval included the value 0. Adult patients with TGA repaired with ATSO in infancy have a greater incidence of dilation of both great vessels, particularly the pulmonary artery. These results may indicate abnormalities in the vascular structure of both great arteries in TGA that may predispose to progressive arterial dilation.
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Thomas B, Martins JDF, Tavares NJ, Lopes A, Pinto FF, Fragata J. Stenosis of the branches of the neopulmonary artery after the arterial switch operation: A cardiac magnetic resonance imaging study. Ann Pediatr Cardiol 2013; 6:29-33. [PMID: 23626432 PMCID: PMC3634242 DOI: 10.4103/0974-2069.107230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: The neonatal arterial switch operation (ASO) is now the standard of care for children born with transposition of the great arteries. Stenosis of the neopulmonary artery on long-term follow up is a known complication. Methods: We performed a retrospective analysis of eleven patients who underwent a cardiac magnetic resonance imaging (MRI) due to echocardiographic evidence suggestive of stenosis of the neopulmonary artery or its branches (mean estimated Doppler gradient 48 mmHg, min 30 mmHg, max 70 mmHg). A comprehensive evaluation of anatomy and perfusion was done by cardiac MRI. Results: The branches of the neopulmonary artery (neo PA) showed decreased caliber in three patients unilaterally and in two patients, bilaterally. Magnetic resonance (MR) perfusion studies showed concomitant decreased flow, with discrepancy between the two lungs of 35/65% or worse, only in the three patients with unilateral obstruction, by two different MR perfusion methods. Conclusions: Cardiac MR can be used as a comprehensive non-invasive imaging technique to diagnose stenosis of the branches of the neopulmonary after the ASO, allowing evaluation of anatomy and function of the neoPA, its branches, and the differential perfusion to each lung, thus facilitating clinical decision making.
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Jonas RA. Editorial comment: Re: The neoaortic root in children with transposition of the great arteries after an arterial switch operation. Eur J Cardiothorac Surg 2013; 43:1108-9. [PMID: 23341040 DOI: 10.1093/ejcts/ezs685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Richard A Jonas
- Department of Cardiac Surgery, Children’s National Heart Institute, Children's National Medical Center, Washington, DC, USA.
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Pees C, Laufer G, Michel-Behnke I. Similarities and differences of the aortic root after arterial switch and ross operation in children. Am J Cardiol 2013; 111:125-30. [PMID: 23062315 DOI: 10.1016/j.amjcard.2012.08.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 08/22/2012] [Accepted: 08/22/2012] [Indexed: 11/26/2022]
Abstract
Pulmonary root dilation and valve regurgitation if translocated into the aortic position is frequently seen in children with transposition of the great arteries (TGA) after an arterial switch operation, as well as in patients after the Ross procedure. Many mechanisms are thought to be responsible for the progressive dilation. Despite the differences between the 2 groups, the similarity of having the pulmonary valve and its adjacent tissue working in the systemic circulation might have a comparable effect on the neoaortic root dimensions and elasticity. We prospectively recruited 52 patients with TGA, 23 Ross patients, and 48 healthy subjects for echocardiographic assessment of their aortic valve, root, sinutubular junction, and ascending aortic dimensions and elasticity. The data were compared, stratified by patient age at investigation and the duration of follow-up postoperatively. In relation to the healthy subjects, the neoaortic root dimensions were significantly larger and the tissue stiffer and less distensible in those with TGA and those who had undergone the Ross procedure. Although the pulmonary valve of the Ross patients had been under systemic pressure load for a significantly shorter period (4.4 ± 3.6 vs 10.1 ± 5.5 years), the dimensions and elasticity values had deteriorated more. These differences could neither be clearly attributed to the age differences at surgery or to an auxiliary congenital ventricular septal defect in those with TGA or the aortic valve phenotype before the Ross operation. In conclusion, the worse outcome of the neoaortic root dimensions and elasticity in the Ross patients should at least be partly related to the different predefined pulmonary artery structures and the different development of the normal and transposed pulmonary arteries.
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Co-Vu JG, Ginde S, Bartz PJ, Frommelt PC, Tweddell JS, Earing MG. Long-term outcomes of the neoaorta after arterial switch operation for transposition of the great arteries. Ann Thorac Surg 2012; 95:1654-9. [PMID: 23218968 DOI: 10.1016/j.athoracsur.2012.10.081] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 10/26/2012] [Accepted: 10/31/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND After the arterial switch operation (ASO) for transposition of the great arteries (TGA), the native pulmonary root and valve function in the systemic position, and the long-term risk for neoaortic root dilation and valve regurgitation is currently undefined. The aim of this study was to determine the prevalence and progression of neoaortic root dilation and neoaortic valve regurgitation in patients with TGA repaired with the ASO. METHODS Measurements of the neoaortic annulus, neoaortic root at the level of the sinuses of Valsalva, and the degree of neoaortic regurgitation were assessed by serial transthoracic echocardiograms on 124 patients with TGA at a median follow-up of 7.2 years (range, 1 to 23 years) after the ASO at our institution. RESULTS Neoaortic root dilation with z scores of 2.5 or greater was identified in 66%, and the root diameter z score increased at an average rate of 0.08 per year over time after ASO. Freedom from neoaortic root dilation at 1, 5, 10, and 15 years after ASO was 84%, 67%, 47%, and 32%, respectively. Risk factors for root dilation include history of double-outlet right ventricle (p = 0.003), previous pulmonary artery banding (p = 0.01), and length of follow-up (p = 0.04). Neoaortic valve regurgitation of at least moderate degree was present in 14%. Neoaortic root dilation was a significant risk factor for neoaortic valve regurgitation (p < 0.0001). No patient required reintervention on the neoaorta or neoaortic valve during follow-up. CONCLUSIONS Progressive neoaortic root dilation is common in patients with TGA after the ASO. Continued surveillance of this population is required.
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Affiliation(s)
- Jennifer G Co-Vu
- Department of Pediatrics, Division of Pediatric Cardiology, Milwaukee, Medical College of Wisconsin, Wisconsin
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Abstract
The successful diagnosis, surgical planning, and long-term care of children with transposition of the great arteries require high-quality cardiac imaging with echocardiography. Echocardiography must identify the relevant anatomic variants of transposition of the great arteries, such as of ventricular septal defects and aortic arch anomalies. Methodical and detailed imaging of the coronary arteries is particularly important, as translocation of the coronary arteries is a critical component of the arterial switch procedure. Familiarity with the potential coronary artery variants and the ideal imaging planes is essential for an echocardiographer. Knowledge of both the early and late complications following the arterial switch procedure is essential to optimise post-operative echocardiography. These complications can include residual lesions leading to haemodynamic compromise or progressive late phenomena, such as aortic root dilatation and aortic insufficiency. Echocardiography will continue to be the cornerstone to the lifelong management of transposition of the great arteries, and improvements in technology and increased familiarity with modalities such as stress echocardiography will enhance the role of advanced imaging even further.
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Frommelt PC, Guey LT, Minich LL, Bhat M, Bradley TJ, Colan SD, Ensing G, Gorentz J, Heydarian H, John JB, Lai WW, Levine JC, Mahle WT, Miller SG, Ohye RG, Pearson GD, Shirali GS, Wong PC, Cohen MS. Does initial shunt type for the Norwood procedure affect echocardiographic measures of cardiac size and function during infancy?: the Single Vventricle Reconstruction trial. Circulation 2012; 125:2630-8. [PMID: 22523314 DOI: 10.1161/circulationaha.111.072694] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Pediatric Heart Network trial comparing outcomes in 549 infants with single right ventricle undergoing a Norwood procedure randomized to modified Blalock-Taussig shunt or right ventricle-pulmonary artery shunt (RVPAS) found better 1-year transplant-free survival in those who received RVPAS. We sought to compare the impact of shunt type on echocardiographic indices of cardiac size and function up to 14 months of age. METHODS AND RESULTS A core laboratory measured indices of cardiac size and function from protocol exams: early after Norwood procedure (age 22.5 ± 13.4 days), before stage II procedure (age 4.8 ± 1.8 months), and at 14 months (age 14.3 ± 1.2 months). Mean right ventricular ejection fraction was <50% at all intervals for both groups and was higher in the RVPAS group after Norwood procedure (49 ± 7% versus 44 ± 8%; P<0.001) but was similar by 14 months. Tricuspid and neoaortic regurgitation, diastolic function, and pulmonary artery and arch dimensions were similar in the 2 groups at all intervals. Neoaortic annulus area (4.2 ± 1.2 versus 4.9 ± 1.2 cm(2)/m(2)), systolic ejection times (214.0 ± 29.4 versus 231.3 ± 28.6 ms), neoaortic flow (6.2 ± 2.4 versus 9.4 ± 3.4 L/min per square meter), and peak arch velocity (1.9 ± 0.7 versus 2.2 ± 0.7 m/s) were lower at both interstage examinations in the RVPAS compared with the modified Blalock-Taussig shunt group (P<0.001 for all), but all were similar at 14 months. CONCLUSIONS Indices of cardiac size and function after the Norwood procedure are similar for modified Blalock-Taussig shunt and RVPAS by 14 months of age. Interstage differences between shunt types can likely be explained by the physiology created when the shunts are in place rather than by intrinsic differences in cardiac function. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00115934.
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Roche SL, Silversides CK, Oechslin EN. Monitoring the Patient with Transposition of the Great Arteries: Arterial Switch Versus Atrial Switch. Curr Cardiol Rep 2011; 13:336-46. [DOI: 10.1007/s11886-011-0185-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lalezari S, Mahtab EA, Bartelings MM, Wisse LJ, Hazekamp MG, Gittenberger-de Groot AC. The Outflow Tract in Transposition of the Great Arteries: An Anatomic and Morphologic Study. Ann Thorac Surg 2009; 88:1300-5. [DOI: 10.1016/j.athoracsur.2009.06.058] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Revised: 06/19/2009] [Accepted: 06/22/2009] [Indexed: 12/01/2022]
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Kołcz J, Januszewska K, Mroczek T, Malec E. Anatomical correction of complex forms of transposition of the great arteries in neonates. SCAND CARDIOVASC J 2009; 38:164-71. [PMID: 15223715 DOI: 10.1080/14017430410028555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The arterial switch operation has become the procedure of choice for the simple transposition of the great arteries (TGA) while in the complex forms of the defect the staged approach is frequently implemented. The aim of this study is to compare groups of patients with simple transposition and children with the complex form of the defect and identify factors affecting early and late outcome. DESIGN From 1997 to 2003, 135 consecutive neonates with TGA underwent arterial switch operation and simultaneous reparation of all associated defects. Univariate and multivariate analysis of perioperative variables and follow-up data was performed. Patients were divided into two groups. Group I (n=84, 62.2%) included neonates with simple transposition (TGA/IVS), Group II (n=51, 37.8%) included children with complex transposition (TGA/VSD). RESULTS Overall early mortality was 8.1% and there was one late death (0.7%). One-month, 1-year and 5-year actuarial survival rates were 91.8, 91.1 and 91.1%, respectively. There were no differences in the early and late survival rate between groups. Reintervention rate for right ventricular outflow tract obstruction (RVOTO) was 13.3% (balloon plasty or reoperation). The freedom from reintervention at 1, 3 and 5 years was 98.4, 87.9 and 85.4%, respectively. There were no differences in the need for reintervention between groups. The significant differences between groups concerned: age at operation (p<0.001), associated anomalies (p=0.002) including aortic arch anomalies (p=0.002) and coronary artery anomalies (p=0.02), application of delayed chest closure (p=0.015), and occurrence of sepsis (p=0.032). Risk factors for early death were: left ventricule dysfunction related to age at operation (p=0.016) and resternotomy in intensive care unit (p<0.001). There were no differences between groups concerning these risk factors as far as circulatory arrest time, aorta clamping time, and early and late morbidity. CONCLUSIONS The arterial switch operation can be the treatment of choice for various forms of TGA with low early and late mortality and morbidity rates. The main cause of early death is still left ventricular dysfunction. Such well-known predictors of poor outcome as presence of ventricular septal defect, coronary artery anomalies and aortic arch anomalies did not affect early and late findings. The presented approach of early simultaneous anatomical correction of TGA and all associated anomalies ensures good condition of children with low necessity for reintervention.
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Affiliation(s)
- Jacek Kołcz
- Department of Pediatric Cardiac Surgery, Polish-American Children's Hospital, Jagiellonian University, Kraków, Poland
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Beaton AZ, Nguyen T, Lai WW, Chatterjee S, Ramaswamy P, Lytrivi ID, Parness IA, Srivastava S. Relation of coarctation of the aorta to the occurrence of ascending aortic dilation in children and young adults with bicuspid aortic valves. Am J Cardiol 2009; 103:266-70. [PMID: 19121449 DOI: 10.1016/j.amjcard.2008.09.062] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 09/04/2008] [Accepted: 09/04/2008] [Indexed: 01/26/2023]
Abstract
Children with bicuspid aortic valve (BAV) have aortic dilation that is present and progressive from birth irrespective of the functional state of the valve. There are no published data comparing aortic dilation in children with BAV with and without aortic coarctation (CoA). The objectives of this study were to (1) compare differences in aortic dimensions and rates of dilation between children with isolated BAV with those of children with BAV and CoA and (2) identify risk factors for the development of aortic dilation. Patients with BAV with CoA (group A) and without CoA (group B) were identified from our echocardiographic database (1993 to 2006). Aortic measurements at 4 levels were obtained, and z scores were compared. Criteria for exclusion were severe aortic regurgitation/stenosis, previous aortic valvuloplasty, complex left-sided cardiac disease, ventricular septal defects, and Turner, Noonan, Williams, and Marfan syndromes. There were 600 echocardiograms in 247 patients. Group A had 192 echocardiograms in 53 patients (median age 11.3 years; range 0 to 30; median follow-up 7 years), and group B had 382 in 194 patients (median age 8.7 years; range 0 to 29; median follow-up 4 years). Group B had significantly greater ascending aorta dimensions (p<0.05) and significantly faster rates of aortic dilation (p<0.0001). The ascending aorta in patients with BAV and CoA did not dilate to the same degree as in patients with isolated BAV. In conclusion, valve morphologic characteristics and function and age at CoA repair had none to minimal impact on aortic dimensions.
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Cho MJ, Park JA, Lee HD, Sung SC, Choo KS. Outcomes of the arterial switch operation in complete transposition of the great arteries. KOREAN JOURNAL OF PEDIATRICS 2009. [DOI: 10.3345/kjp.2009.52.8.910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Min Jung Cho
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan, Korea
| | - Ji Ae Park
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan, Korea
| | - Hyoung Doo Lee
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan, Korea
| | - Si Chan Sung
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Children's Hospital, Pusan, Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University Children's Hospital, Pusan, Korea
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Kaiser T, Kellenberger CJ, Albisetti M, Bergsträsser E, Valsangiacomo Buechel ER. Normal values for aortic diameters in children and adolescents--assessment in vivo by contrast-enhanced CMR-angiography. J Cardiovasc Magn Reson 2008; 10:56. [PMID: 19061495 PMCID: PMC2615773 DOI: 10.1186/1532-429x-10-56] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 12/05/2008] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Contrast-enhanced CMR angiography (CE-CMRA) is being increasingly used for diagnosing aortic arch anomalies, planning interventions and follow-up assessment. We sought to establish normal values for the diameters of the thoracic aorta and reference curves related to body growth in children using CE-CMRA. RESULTS CE-CMRA was performed in 53 children without cardiovascular disease. The median age was 9 years (range 2 - 20 years), weight 30 kg (range 12 - 75 kg), height 131 cm (range 81 - 184 cm), body surface area (BSA) 1.05 m2 (range 0.52-1.9 m2). Aortic diameters were measured at nine standardized sites on oblique maximum-intensity projection (MIP) images. Regression analysis of diameters in relation to BSA demonstrated linear relationship between the cross-sectional aortic diameters and the square root of BSA (BSA0.5). Normative diameters were (0.57 + 19.37*BSA0.5) mm for the aortic sinus, (-3.52 + 18.66*BSA0.5) mm for the first segment of the aortic arch, (-3.37 + 16.52*BSA0.5) mm for the isthmic region and (-1.27 + 9.89*BSA0.5) mm for the descending aorta at the level of the diaphragm. Normative curves are presented. CONCLUSION This study provides normative values for aortic diameters in children measured by CE-CMRA. These data may serve for making the diagnosis of pediatric arch anomalies, assessing the need for treatment and planning interventions.
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Affiliation(s)
- Thomas Kaiser
- Division of Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland
| | | | - Manuela Albisetti
- Division of Pediatrics, University Children's Hospital, Zurich, Switzerland
| | - Eva Bergsträsser
- Division of Pediatric Oncology, University Children's Hospital, Zurich, Switzerland
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Grotenhuis HB, Ottenkamp J, Fontein D, Vliegen HW, Westenberg JJM, Kroft LJM, de Roos A. Aortic Elasticity and Left Ventricular Function after Arterial Switch Operation: MR Imaging—Initial Experience. Radiology 2008; 249:801-9. [PMID: 18941160 DOI: 10.1148/radiol.2492072013] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Heynric B Grotenhuis
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, C2-S, 2300 RC Leiden, The Netherlands
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36
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de Koning WB, van Osch-Gevers M, Ten Harkel ADJ, van Domburg RT, Spijkerboer AW, Utens EMWJ, Bogers AJJC, Helbing WA. Follow-up outcomes 10 years after arterial switch operation for transposition of the great arteries: comparison of cardiological health status and health-related quality of life to those of the a normal reference population. Eur J Pediatr 2008; 167:995-1004. [PMID: 17987315 DOI: 10.1007/s00431-007-0626-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Revised: 10/01/2007] [Accepted: 10/02/2007] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to investigate the cardiological health status and health-related quality of life after the arterial switch operation (ASO) for transposition of the great arteries (TGA) in comparison with a normative reference group. Chart review and cross-sectional systematic follow-up, including echocardiography, exercise testing, and electrocardiography, were performed on all survivors of ASO for TGA between 1990 and 1995. Health-related quality of life (HRQOL) was assessed using a standardized questionnaire. A normative reference group was included. Forty-nine survivors [median age at operation 13 days, mean age at follow-up 11 +/- 2 years (37/49 with intact ventricular septum] were identified. Thirty-three of 49 patients (67%) [22/33 TGA with intact ventricular septum (IVS)] participated in cross-sectional follow-up. Cumulative 10-year event-free survival was 88% and the re-intervention rate 6%. Aortic root dilatation occurred in 70% of patients; none had severe aortic regurgitation. Left ventricular function was normal. Exercise performance (85% of reference capacity, p = 0.02), maximal oxygen uptake (85%, p < 0.01) and peak heart rate (95%, p < 0.01) were decreased. Exercise electrocardiogram was normal as was rhythm status. Unfavourable outcomes on HRQOL were found for motor functioning and positive emotional functioning. Overall there were no significant differences between TGA/IVS and TGA/VSD. We conclude that at mid- to long-term follow-up after ASO, major events and re-interventions (6%) occur infrequently. Exercise capacity and maximal oxygen uptake are lower than those in a reference population, which could not be related to diminished ventricular function. Aortic root dilatation is frequent, irrespective of the anatomical subgroup. Severe aortic regurgitation or left ventricular dilatation was not found. The unfavourable health-related quality of life deserves further attention.
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Affiliation(s)
- Wilfred B de Koning
- Department of Paediatrics (Division of Cardiology), Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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Gaca AM, Jaggers JJ, Dudley LT, Bisset GS. Repair of Congenital Heart Disease: A Primer–Part 1. Radiology 2008; 247:617-31. [DOI: 10.1148/radiol.2473061909] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Agnoletti G, Ou P, Celermajer DS, Boudjemline Y, Marini D, Bonnet D, Aggoun Y. Acute angulation of the aortic arch predisposes a patient to ascending aortic dilatation and aortic regurgitation late after the arterial switch operation for transposition of the great arteries. J Thorac Cardiovasc Surg 2008; 135:568-72. [DOI: 10.1016/j.jtcvs.2007.10.020] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Revised: 08/18/2007] [Accepted: 10/16/2007] [Indexed: 11/30/2022]
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Bové T, De Meulder F, Vandenplas G, De Groote K, Panzer J, Suys B, DeWolf D, François K. Midterm Assessment of the Reconstructed Arteries After the Arterial Switch Operation. Ann Thorac Surg 2008; 85:823-30. [DOI: 10.1016/j.athoracsur.2007.10.043] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 10/09/2007] [Accepted: 10/10/2007] [Indexed: 11/17/2022]
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Yuan SM, Shinfeld A, Tager S, Raanani E. Onset of neoaortic root dilation 18 years after an arterial switch operation. J Cardiovasc Med (Hagerstown) 2008; 9:298-300. [PMID: 18301152 DOI: 10.2459/jcm.0b013e32815aa5e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It has been claimed that neoaortic root dilatation or enlargement with aortic regurgitation is progressive until 11 years after an arterial switch operation. We report a case of neoaortic root dilatation onset occurring 18 years after operation and discuss the pathological features and the possible acting mechanisms.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiac and Thoracic Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel
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Lovato L, Giardini A, La Palombara C, Russo V, Gostoli V, Gargiulo G, Picchio FM, Fattori R. Role and effectiveness of cardiovascular magnetic resonance in the diagnosis, preoperative evaluation and follow-up of patients with congenital heart diseases. Radiol Med 2007; 112:660-80. [PMID: 17673954 DOI: 10.1007/s11547-007-0171-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Accepted: 11/20/2006] [Indexed: 10/23/2022]
Abstract
The substantial advances in the medical and surgical treatment of congenital heart diseases have dramatically improved patients' life expectancy, as well as increased the number of those needing lifelong monitoring to identify complications and residual defects. Magnetic resonance imaging (MRI) is an ideal imaging modality for the follow-up of these young patients owing to its noninvasiveness, high reproducibility and morphological and functional accuracy. This paper describes the most appropriate MRI techniques and sequences for the study of cardiovascular heart diseases on the basis of an analysis of MRI studies carried out between January 2003 and June 2006 on 274 patients affected by all of the main congenital cardiovascular malformations, as well as a review of the literature. The advantages of MRI with respect to other imaging techniques, the problems encountered and the main clinical applications and indications of MRI, with special reference to the most common disease entities, are then discussed to define the role, the utility and the future perspectives of this imaging technique in the study of congenital heart diseases.
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Affiliation(s)
- L Lovato
- US di Radiologia Cardiovascolare, Università di Bologna, Bologna, Italy.
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Holmes KW, Lehmann CU, Dalal D, Nasir K, Dietz HC, Ravekes WJ, Thompson WR, Spevak PJ. Progressive dilation of the ascending aorta in children with isolated bicuspid aortic valve. Am J Cardiol 2007; 99:978-83. [PMID: 17398196 DOI: 10.1016/j.amjcard.2006.10.065] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Revised: 10/30/2006] [Accepted: 10/30/2006] [Indexed: 11/20/2022]
Abstract
Although patients with bicuspid aortic valves (BAVs) are predisposed to ascending aortic (AA) dilation, stenosis, and dissection, the development of aortic disease in children with BAVs is poorly described. The purposes of this study were to determine the rate of change of AA diameter in children with BAVs and to identify risk factors for the development of aortic dilation. The echocardiograms of 276 children aged<19 years (mean 8.5+/-5.3) with isolated BAVs were reviewed. Aortic measurements were normalized to z scores on the basis of body surface area. In a subset of 112 patients with serial examinations, aortic growth rates were calculated and risk factors for more rapid aortic growth determined. At presentation, 33 patients (12%) demonstrated marked AA dilation (z>4), and 70 (25%) were moderately abnormal (z between 2 and 4). The mean+/-SD AA diameter increased more than expected, at a rate of 0.18+/-0.30 z score per year (p<0.0001). In 61 patients with normal AA diameters on initial study, 22 (36%) had abnormal diameters, with z scores>2, at follow-up. Univariate analysis demonstrated right-noncoronary commissural fusion (p<0.02) and aortic valve gradient on initial examination (p<0.02) as significant predictors of AA growth. In multivariate analysis, however, the significance of gradient and valve morphology was diminished (p = 0.06 for both). In conclusion, the progression of AA diameter in patients with normal z scores on initial examination suggests that serial echocardiograms are required to screen for the development of significant aortic dilation.
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Affiliation(s)
- Kathryn W Holmes
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA.
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Bautista-Hernandez V, Marx GR, Bacha EA, del Nido PJ. Aortic Root Translocation Plus Arterial Switch for Transposition of the Great Arteries With Left Ventricular Outflow Tract Obstruction. J Am Coll Cardiol 2007; 49:485-90. [PMID: 17258095 DOI: 10.1016/j.jacc.2006.09.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Revised: 09/08/2006] [Accepted: 09/11/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The goal of our study was to report our intermediate-term results with aortic root translocation plus arterial switch for d-transposition of the great arteries with left ventricular outflow tract obstruction. BACKGROUND A d-transposition of the great arteries with left ventricular outflow tract obstruction represents a difficult surgical problem. The Rastelli procedure is the usual approach to this condition. However, recurrent left ventricular outflow tract obstruction and early conduit obstruction as well as arrhythmias and troublesome late mortality are significant limitations. METHODS From 1993 to 2005, 11 children (8 male, 3 female) ages 1 month to 11 years (median age 7 months) have undergone aortic root autograft translocation plus arterial switch to correct d-transposition of the great arteries with left ventricular outflow tract obstruction. The native aortic root was excised from the right ventricle infundibulum and inserted into the left ventricular outflow, enlarging the outflow tract by resecting the outlet septum and an appropriate-size ventricular septal defect patch. After coronary artery reimplantation, right ventricular outflow reconstruction was achieved with a homograft. RESULTS There were no early or late deaths. With a median follow-up of 59 months (range 2 to 137 months), 5 patients required 6 conduit replacement procedures at a median time of 53 months. Two patients required an implantable defibrillator for ventricular arrhythmias. None of the patients have developed left ventricular outflow tract obstruction. CONCLUSIONS Aortic root autograft plus arterial switch procedure is a good option for the surgical management of infants and children with d-transposition of the great arteries and left ventricular outflow tract obstruction and results in a more anatomic repair compared with Rastelli operation. Intermediate-term results indicate good relief of left ventricular outflow tract obstruction and need for conduit replacement compares favorably with the Rastelli procedure for this lesion.
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Affiliation(s)
- Victor Bautista-Hernandez
- Department of Cardiac Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA
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Marino BS, Wernovsky G, McElhinney DB, Jawad A, Kreb DL, Mantel SF, van der Woerd WL, Robbers-Visser D, Novello R, Gaynor JW, Spray TL, Cohen MS. Neo-aortic valvar function after the arterial switch. Cardiol Young 2006; 16:481-9. [PMID: 16984700 DOI: 10.1017/s1047951106000953] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2006] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The purpose of our study was to assess the prevalence and progression, during childhood and adolescence, of dilation of the neo-aortic root, and neo-aortic valvar regurgitation, and to identify risk factors for such dilation and regurgitation, after the arterial switch operation. METHODS We included all patients who had undergone an arterial switch operation at The Children's Hospital of Philadelphia, and had been followed for a minimum of 4 years, and had at least 2 postoperative echocardiograms. Neo-aortic valvar regurgitation was quantitatively assessed, and measurements were made of the neo-aortic root at the level of the basal attachment of the leaflets, mid-sinusal level, and the sinutubular junction. RESULTS We found 82 patients who satisfied the criterions for inclusion, of whom 52 patients had transposition with an intact ventricular septum, and 30 had either an associated ventricular septal defect or double outlet right ventricle. The median follow-up time was 8.8 years (4.1 to 16.4 years). The neo-aortic valve had been replaced in 1 patient. Of the patients, 3 had moderate, 66 had trivial to mild, and 12 had no neo-aortic valvar regurgitation at their most recent follow-up. The regurgitation had progressed by at least 1 grade in 38 of the 82 patients (46.4%). Neo-aortic dilation was noted at the basal attachment of the leaflets, and at mid-sinusal level, which was out of proportion to somatic growth. CONCLUSIONS At mid-term follow-up, significant neo-aortic valve regurgitation is present in 3.7%, and trivial to mild regurgitation in 81.4% of patients. The regurgitation progressed in almost half of the patients over time. We also noted progressive dilation of the neo-aortic root out of proportion to somatic growth.
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Affiliation(s)
- Bradley S Marino
- Cardiac Center, Children's Hospital of Philadelphia and Department of Pediatrics, University of Pennsylvania School of Medicine, United States of America.
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Dohmen PM, da Costa F, Holinski S, Lopes SV, Yoshi S, Reichert LH, Villani R, Posner S, Konertz W. Is there a possibility for a glutaraldehyde-free porcine heart valve to grow? Eur Surg Res 2006; 38:54-61. [PMID: 16490995 DOI: 10.1159/000091597] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2005] [Accepted: 12/22/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE A challenging issue is to create a heart valve with growth and remodeling potential, which would be of great interest for congenital heart valve surgery. This study was performed to evaluate the growth and remodeling potentials of a decellularized heart valve. METHODS In 4 juvenile sheep (age 12 +/- 1 weeks) with a weight of 24.3 +/- 4.4 kg, a 17-mm diameter decellularized porcine valve was implanted as pulmonary valve replacement. Valve growth was evaluated by transthoracic echocardiography. At explantation, valves were evaluated by gross examination, light microscopy (hematoxylin and eosin, von Kossa, Sirius red, Weigert and Gomori staining), electron microscopy and immunohistochemistry. Atomic absorption spectrometry was performed to evaluate calcium content. RESULTS All animals showed fast recovery. The mean follow-up was 9.0 +/- 1.8 months. All sheep at least doubled their weight (54.3 +/- 9.2 kg). Echocardiography showed no regurgitation and a flow velocity of 0.7 +/- 0.1 m/s at the latest follow-up. The valve diameter increased from 17.6 +/- 0.5 to 27.5 +/- 2.1 mm (p < 0.018). Gross examination showed a similar wall thickness of the implanted valve and native pulmonary wall, with smooth and pliable leaflets. Histology showed a monolayer of endothelial cells, fibroblast ingrowth and production of new collagen. No calcification was seen at von Kossa staining, confirmed by low calcium content levels of the valve wall and leaflets at atomic absorption spectrometry. CONCLUSIONS This glutaraldehyde-free heart valve showed not only the absence of calcification, but also remodeling and growth potential.
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Affiliation(s)
- P M Dohmen
- Department of Cardiovascular Surgery, Charité Hospital, Medical University, Berlin, Germany.
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Ehsan A, Singh H, Vargas SO, Sachweh J, Jonas RA. Neoaortic Aneurysm After Stage I Norwood Reconstruction. Ann Thorac Surg 2005; 79:e23-5. [PMID: 15734369 DOI: 10.1016/j.athoracsur.2004.10.056] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2004] [Indexed: 11/16/2022]
Abstract
Treatment of hypoplastic left heart syndrome through staged repairs has resulted in patients surviving into adulthood. Use of either aortic or pulmonary homografts in performing the neoaortic reconstruction has become the standard of practice with relatively few problems. We report the case of an asymptomatic adolescent boy who had an enlarging neoaortic aneurysm and mild neoaortic regurgitation develop after undergoing a stage I Norwood procedure using a pulmonary homograft. Given the risk for rupture and a concern for further functional deterioration of the neoaortic valve, the patient underwent repair. Histologic examination showed a striking accumulation of myxoid material as well as abnormal vasculature in both the native and engrafted portions of the neoaorta.
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Affiliation(s)
- Afshin Ehsan
- Division of Cardiothoracic Surgery, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
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47
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Jonas RA. The Ross procedure is not the procedure of choice for the teenager requiring aortic valve replacement. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2005:176-80. [PMID: 15818375 DOI: 10.1053/j.pcsu.2005.01.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The Ross procedure was a remarkable technical achievement when it was introduced in 1967. Although the long-term results for the procedure when performed in adults using the technique of intra-aortic subcoronary freehand implantation have been satisfactory, the results for children using the technique of complete aortic root replacement have been less satisfactory. Not only have early outgrowth, calcification, and shrinkage of the pulmonary homograft used to reconstruct the right ventricular outflow tract been a problem but in addition some children have experienced excessive dilation of the neoaortic root as well as neoaortic valve regurgitation. In contrast to the Ross procedure, aortic valve repair and other forms of aortic valve replacement do not exclude the possibility of reoperation in the future using more advanced options such as tissue engineered leaflets or valves. Until more information is available regarding long-term performance of the pulmonary root when implanted as a neoaortic root, as well as improved results for reconstruction of the right ventricular outflow tract, the Ross procedure should be used rarely.
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Affiliation(s)
- Richard A Jonas
- Department of Cardiac Surgery, Children's National Heart Institute, Washington, DC 20010, USA
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McMahon CJ, Ravekes WJ, Smith EO, Denfield SW, Pignatelli RH, Altman CA, Ayres NA. Risk factors for neo-aortic root enlargement and aortic regurgitation following arterial switch operation. Pediatr Cardiol 2004; 25:329-35. [PMID: 14727099 DOI: 10.1007/s00246-003-0483-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objectives of this study were to evaluate changes in dimension of the neo-aortic annulus, aortic root, and aortic anastomosis following arterial switch operation (ASO) and to identify risk factors for developing abnormal neo-aortic root enlargement and aortic regurgitation (AR). Prior studies report development of neo-aortic root dilatation and AR in a small subset of patients after ASO. Predisposing factors for neo-aortic root dilatation and development of moderate/severe AR are poorly understood. We performed a retrospective review of all patients with d-transposition of the great arteries (d-TGA) or double-outlet right ventricle with subpulmonary ventricular septal defect (VSD) who underwent ASO from May 1986 to January 2001. Serial echocardiograms were reviewed to measure neo-aortic annulus, root, and anastomosis diameter (z scores) and to determine progression of AR. Potential risk factors were assessed for developing neo-aortic root enlargement and AR. There were 119 patients (44 female and 75 male): 73 patients had simple d-TGA, 36 had d-TGA with ventricular septal defect, and 10 had a Taussig-Bing heart. The median duration of follow-up was 65 months (range, 12-180). The median neo-aortic root (z = 0.55+/-2.2; p < 0.01) and aortic annulus dimensions (z = 1.57+/-1.75; p < 0.01) were significantly increased over the study period. Aortic anastomosis diameter correlated with growth of the ascending aorta (z = 0.55+/-1.24). Development of severe neo-aortic root enlargement was associated with prior pulmonary artery (PA) banding (p < 0.01), the presence of a VSD (p = 0.03), and Taussig-Bing anatomy (p < 0.01) but was independent of coronary arterial anatomy, coronary arterial transfer technique, or associated lesions (p > 0.05). At latest follow-up, there was no or trivial AR in 88 patients, mild AR in 29 patients, and moderate to severe AR in 3 patients. Risk factors for developing mild or worse AR included severe or rapid neo-aortic root dilatation (p < 0.01). Only 3 patients required surgical intervention for AR. Despite the significant prevalence of neo-aortic root enlargement at intermediate follow-up after ASO, there is a low incidence of significant AR. Prior PA banding, the presence of VSD, and Taussig-Bing anatomy are risk factors for severe root enlargement. Surgical intervention for AR was rare (2%), however, serial surveillance of such patients is vital to monitor for neo-aortic root enlargement and potential aortic valve dysfunction.
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Affiliation(s)
- C J McMahon
- Lillie Frank Abercrombie Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX 77030, USA.
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Mohammadi S, Serraf A, Belli E, Aupecle B, Capderou A, Lacour-Gayet F, Martinovic I, Piot D, Touchot A, Losay J, Planché C. Left-sided lesions after anatomic repair of transposition of the great arteries, ventricular septal defect, and coarctation: Surgical factors. J Thorac Cardiovasc Surg 2004; 128:44-52. [PMID: 15224020 DOI: 10.1016/j.jtcvs.2004.01.040] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study was undertaken to identify potential anatomic and surgical factors creating left-sided lesions, namely recoarctation of the aorta and neoaortic regurgitation, after anatomic repair of transposition of the great arteries with ventricular septal defect and aortic coarctation. METHODS From 1983 to September 2002, 109 survivors out of 120 patients were studied. Two-stage repair was performed in 42 patients (group A), and single-stage repair was performed in 67 (groups B and C). Before repair, the diameters of the ascending aorta and main pulmonary artery were measured. In the patients with single-stage repair, coarctation was repaired by extended end-to-end anastomosis in 35 patients (group B) and by pulmonary homograft patch augmentation in 32 patients (group C). The ventricular septal defect was closed through the pulmonary artery in 70 patients and through the right ventricle or atrium in 39 patients. The neoaorto-aortic discrepancy was treated by V-shaped resection of the posterior sinus of Valsalva in 7 cases, pulmonary homograft patch in 32 cases, and anterior splitting of the ascending aorta in all cases. Before discharge from the hospital, neoaortic root and ascending aorta diameters and aortic regurgitation grade were recorded. Neoaortic regurgitation progression and reintervention were the end points of follow-up (97.2 +/- 61.2 months). RESULTS Early and late survivals were significantly better in group C (P <.001). Risk factors for neoaortic regurgitation at discharge by univariate analysis were single-stage repair (P <.05) and ventricular septal defect closure through the pulmonary artery (P =.0076). On multivariate analysis, the latter was the only risk factor for neoaortic regurgitation at discharge and at last follow-up. Multivariate analysis showed that higher neoaortic root/ascending aorta ratio and ventricular septal defect closure through the pulmonary artery were risk factors for neoaortic regurgitation evolution at last follow-up. There were 29 reinterventions, 19 for recoarctation of the aorta and 10 for neoaortic regurgitation with or without aortic root dilatation. Group B (P <.05), high neoaortic root/ascending aorta ratio (P <.01), and progressive neoaortic regurgitation (P <.05) were risk factors for recoarctation of the aorta. Group A was a risk factor for aortic valve replacement at 10 years (P <.05). CONCLUSION Neonatal single-stage repair with pulmonary homograft aortic augmentation remains the optimal approach to transposition of the great arteries with ventricular septal defect and aortic coarctation. It provides better early and late survivals and freedoms from left-sided lesions. Avoidance of late recoarctation of the aorta and progressive neoaortic regurgitation requires meticulous closure of the ventricular septal defect and evenly sized reconstruction of the aorta from root to distal arch.
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Affiliation(s)
- Siamak Mohammadi
- Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Le Plessis-Robinson, France
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Formigari R, Toscano A, Giardini A, Gargiulo G, Di Donato R, Picchio FM, Pasquini L. Prevalence and predictors of neoaortic regurgitation after arterial switch operation for transposition of the great arteries. J Thorac Cardiovasc Surg 2003; 126:1753-9. [PMID: 14688683 DOI: 10.1016/s0022-5223(03)01325-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The fate of the native pulmonary valve after arterial switch operation is still unknown and may become a cause for a secondary aortic valve operation during adult life. We evaluated the prevalence and predictive factors associated with neoaortic valvular regurgitation by a retrospective study of children who underwent arterial switch operation for transposition of the great arteries. METHODS The onset of neoaortic valvular regurgitation was correlated with demographic data, cardiac anatomy, surgical technique, and postoperative ventricular function. The size of the neoaortic root and ascending aorta was measured in a selected subset of patients. RESULTS Among 253 survivors, 173 were eligible for the study. After a median follow-up time of 8.2 years, 61 patients showed echocardiographic or angiographic evidence of valvular incompetence, which was progressive in 14 cases; this led to surgical intervention in 2 patients, and there was 1 operative death. At multivariate analysis, the onset of valvular regurgitation was correlated with the trap-door technique for coronary reimplantation (P <.01). A smooth transition from the aortic sinus to the ascending aorta, with loss of the normal sinotubular junction geometry, may be associated with valvular incompetence. CONCLUSIONS After arterial switch operation, there is an increasing frequency of neoaortic regurgitation, which may lead to significant valvular dysfunction later in life. The trap-door type of coronary reimplantation is associated with an increased risk for valvular dysfunction, possibly because of a distortion of the sinotubular junction geometry. For this reason, we recommend the punch technique for repair in all but the most complicated coronary pattern.
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Affiliation(s)
- Roberto Formigari
- Pediatric Cardiology and Cardiac Surgery, University of Bologna, Italy.
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