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Adequate left ventricular preparation allows for arterial switch despite late referral

Published online by Cambridge University Press:  18 April 2005

Antonio F. Corno ,
Michel Hurni ,
Maurice Payot ,
Nicole Sekarski ,
Piergiorgio Tozzi  and
Ludwig K. von Segesser
Antonio F. Corno
Affiliation:
Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Michel Hurni
Affiliation:
Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Maurice Payot
Affiliation:
Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Nicole Sekarski
Affiliation:
Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Piergiorgio Tozzi
Affiliation:
Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Ludwig K. von Segesser
Affiliation:
Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Abstract

Objective: To evaluate the feasibility of the arterial switch for surgical repair of transposition, defined as the combination of concordant atrioventricular and discordant ventriculo-arterial connections, after late referral. Methods: From March 2000 to August 2001, six children underwent an arterial switch procedure following left ventricular preparation because of late referral. The mean age at referral was 8.3 months, with a range from 3 to 25 months, and mean body weight was 5.3 kg, with a range from 3.7 to 9.3 kg. The mean saturation of oxygen was 57%, with a range from 50 to 72%. Associated defects included a restrictive ventricular septal defect in three patients, aortic coarctation in one, and partially anomalous pulmonary venous connection in one. The mean interval between referral and the arterial switch procedure was 3.7 months, within a range from 1 to 7 months. A mean of 1.5 surgical procedures were undertaken to prepare the left ventricle, the most being 3 procedures, including combinations of creation of an inter-atrial communication in four patients, banding of the pulmonary trunk in five, and creation of a systemic-to-pulmonary arterial shunt in three. We evaluated left ventricle ejection and shortening fractions, left ventricular diastolic diameter and volume, right and left ventricular wall thicknesses, and the ratio of right to left ventricular values by echocardiography at referral, immediately before, and one week after the arterial switch procedure. Results: All children are alive and well, with a mean follow-up of 17 months, ranging from 9 to 26 months. Echocardiography showed a statistically significant decrease of the ratio between right and left ventricular wall thicknesses, from 1.33 ± 0.26 at referral to 0.79 ± 0.08 before the switch procedure (p < 0.005). Left ventricular function was adequate after arterial switch, with a mean ejection fraction of 79.3%, ranging from 66 to 87%, and a mean shortening fraction of 41.7%, ranging from 30 to 49%. Conclusions: Despite late referral, and initially inadequate left ventricular volume and mural thickness, children with transposition can successfully be treated with the arterial switch procedure, provided that the left ventricle is adequately prepared, using echocardiography to monitor left ventricular morphology and function.

Keywords

Congenital cardiac surgerybanding of pulmonary trunktransposition of the great arteries
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 1 , February 2003 , pp. 49 - 52
Copyright
© 2003 Cambridge University Press

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Footnotes

Presented at the 37th Annual General Meeting of the Association for European Pediatric Cardiology, Porto, May 15–18, 2002

References

de Leval MR. Lessons from the arterial switch operation. Lancet 2001; 357: 1814.Google Scholar
Corno AF, von Segesser LK. Transposition of great arteries and single coronary artery: a new surgical technique for the arterial switch operation. Swiss Med Wkly 2001; 131: 47–49.Google Scholar
Yacoub M, Radley-Smith R, Maclaurin R. Two stage operation for anatomical correction of transposition of the great arteries with intact ventricular septum. Lancet 1977; 1: 1275–1278.Google Scholar
Castaneda AR, Norwood WI, Jonas RA, Colan SD, Sanders SP, Lang P. Transposition of the great arteries with intact ventricular septum: anatomical repair in neonates. Ann Thorac Surg 1984; 38: 438–443.Google Scholar
Jonas RA, Giglia TM, Sanders SP, Wernovski G, Castaneda AR. Rapid two stage arterial switch for transposition of the great arteries with intact ventricular septum beyond the neonatal period. Circulation 1989; 80 (Suppl I): 203–208.Google Scholar
Davis AM, Wilkinson JL, Karl TR, Mee RB. Transposition of the great arteries with intact ventricular septum. Arterial switch repair in patients 21 days of age or older. J Thorac Cardiovasc Surg 1993; 106: 111–115.Google Scholar
Foran JP, Sullivan ID, Elliott MJ, de Leval MR. Primary arterial switch operation for transposition of the great arteries with intact ventricular septum in infants older than 21 days. J Am Coll Cardiol 1998; 31: 883–889.Google Scholar
Mee RB, Harada Y. Retraining of the left ventricle with a left ventricular assist device (Bio-Medicus) after the arterial switch operation. J Thorac Cardiovasc Surg 1991; 101: 171–173.Google Scholar
Naughton P, Mossad E. Retraining the left ventricle after arterial switch operation: emerging uses for the left ventricular assist device in pediatric cardiac surgery. J Cardiothorac Vasc Anesth 2000; 14: 454–456.Google Scholar
Helvind MH, McCarthy JF, Imamura M, et al. Ventriculo-arterial discordance: switching the morphologically left ventricle into the systemic circulation after 3 months of age. Eur J Cardiothorac Surg 1998; 14: 173–178.Google Scholar
Iyer KS, Sharma R, Kumar K, et al. Serial echocardiography for decision making in rapid two-stage arterial switch operation. Ann Thorac Surg 1995; 60: 658–664.Google Scholar
Lacour-Gayet F, Piot D, Zoghbi J, et al. Surgical management and indication of left ventricular retraining in arterial switch for transposition of the great arteries with intact ventricular septum. Eur J Cardiothorac Surg 2001; 20: 824–829.Google Scholar
Laohaprasitiporn D, Nana A, Soongswang J, et al. Results of rapid two-stage arterial switch operation in patients with transposition of the great arteries: one-year postoperation. J Med Assoc Thai 1998; 81: 866–871.Google Scholar
Sidi D, Planché C, Kachaner J, Villain E, Lacour-Gayet F. Anatomic correction of simple transposition of the great arteries in 50 neonates. Circulation 1987; 75: 429–435.Google Scholar
Nakazawa M, Oyama K, Imai Y, et al. Criteria for two-staged arterial switch operation for simple transposition of great arteries. Circulation 1988; 78: 124–131.Google Scholar
Boutin C, Wernovsky G, Sanders SP, Jonas RA, Castaneda AR, Colan SD. Rapid two-stage arterial switch operation. Evaluation of left ventricular systolic mechanics late after an acute pressure overload stimulus in infancy. Circulation 1994; 90: 1294–1303.Google Scholar
Boutin C, Jonas RA, Sanders SP, Wernovsky G, Mone SM, Colan SD. Rapid two-stage arterial switch operation. Acquisition of left ventricular mass after pulmonary artery banding in infants with transposition of the great arteries. Circulation 1994; 90: 1304–1309.Google Scholar
Devereux RB, Alonso DR, Lutas EM, et al. Echocardiography assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986; 57: 450–458.Google Scholar
Corno AF, Horisberger J, Boone Y, et al. Assistance cardiaque mécanique pédiatrique. Rev Med Suisse Romande 2002; 122: 137–140.Google Scholar
Wernovsky G, Giglia TM, Jonas RA, Mone SM, Colan SD, Wessel DL. Course in the intensive care unit after “preparatory” pulmonary artery banding and aortopulmonary shunt placement for transposition of the great arteries with low left ventricular pressure. Circulation 1992; 86 (Suppl II): 33–39.Google Scholar
di Donato RM, Fujii AM, Jonas RA, Castaneda AR. Age-dependent ventricular response to pressure overload. Considerations for the arterial switch operation. J Thorac Cardiovasc Surg 1992; 104: 713–722.Google Scholar
McLeod KA, De Giovanni J, Silove E, Alton H, Poyner R, Brawn WJ. Myocardial perfusion scanning in patients considered for late arterial switch. Cardiol Young 2000; 10: 21–26.Google Scholar
Padalino MA, Stellin G, Brawn WJ, et al. Arterial switch operation after left ventricular retraining in the adult. Ann Thorac Surg 2000; 70: 1753–1757.Google Scholar
Hon JK, Steendijk P, Khan H, Wong K, Yacoub M. Acute effects of pulmonary artery banding in sheep on right ventricle pressure-volume relations: relevance to the arterial switch operation. Acta Physiol Scand 2001; 172: 97–106.Google Scholar
Wong K, Boheler KR, Petrou M, Yacoub M. Pharmacological modulation of pressure-overload cardiac hypertrophy: changes in ventricular function, extra-cellular matrix, and gene expression. Circulation 1997; 96: 2239–2246.Google Scholar
Corno AF, Milano G, Samaja M, Tozzi P, von Segesser LK. Chronic hypoxia: a model for cyanotic heart defects. J Thorac Cardiovasc Surg 2002; 124: 105–112.Google Scholar
Milano G, Corno AF, von Segesser LK, Samaja M. Chronic and intermittent hypoxia induce different degrees of myocardial tolerance to hypoxia-induced dysfunction. Exper Biol Med 2002; 227: 389–397.Google Scholar