Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-27T22:33:19.807Z Has data issue: false hasContentIssue false
  • English
  • Français

Should we standardise the pre-operative management of babies with complete transposition?

Published online by Cambridge University Press:  19 August 2008

T. S. Hornung  and
J. J. O'sullivan
T. S. Hornung*
Affiliation:
Department of Paediatric Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
J. J. O'sullivan
Affiliation:
Department of Paediatric Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
*
Dr. T.S. Hornung, Adult Congenital Cardiac Centre, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. Tel: 020 7352 8121; E-mail: tim.hornung@virgin.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Complete transposition is the most common form of neonatal cyanotic heart disease. The management of this condition has changed markedly in the last decade and there appears to be a significant variation between centres in terms of pre-operative management.

Objectives / Methods

We surveyed all paediatric cardiac surgical centres in the United Kingdom regarding pre-operative management, particularly performance and timing of balloon atrial septostomy and aortogram, imaging techniques used and discharge prior to surgery.

Results

There is significant variation in pre-operative management: 10 centres now perform septostomy outside the catheter lab and 11 without general anaesthesia. Eight centres use echo control only and only 3 perform routine aortograms. Three centres do not perform routine septostomy. The most common age for arterial switch was at 1–2 weeks, but some routinely performed this procedure up to 1 month of age and others aim for arterial switch before one week of age. Only 3 centres routinely discharge patients between septostomy and switch.

Conclusions

Despite a trend towards echo guided septostomy and earlier arterial switch there is still considerable variation in early management of patients with transposition of the great arteries. Debate within the profession leading to a more standardised pre-operative management strategy would protect both the patient and the doctor involved in the care of children with complete transposition.

Keywords

Transposition of the great arteriesarterial switchballoon atrial septostomy
Type
Original Articles
Information
Cardiology in the Young , Volume 10 , Issue 5 , September 2000 , pp. 458 - 460
Copyright
Copyright © Cambridge University Press 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Jatene, AD, Fontes, VF, Paulista, PP, Souza, LC, Neger, F, Galantier, M, Sousa, JE. Anatomic correction of transposition of the great vessels. J Thorac Cardiovasc Surg 1976;72: 364–370.CrossRefGoogle ScholarPubMed
2.Castañeda, AR, Norwood, WI, Jonas, RA, Colan, SD, Sanders, SP, Lang, PTransposition of the great arteries and intact ventricular septum: anatomical repair in the neonate. Ann Thorac Surg 1984;38: 438–443.CrossRefGoogle ScholarPubMed
3.Serraf, A, Lacour-Gayet, F, Bruniaux, J, Touchot, A, Losay, J, Comas, J, Sousa Uva, M. Planche, C. Anatomic correction of transposition of the great arteries in neonates. J Am Coll Cardiol 1993;22: 193–200.CrossRefGoogle ScholarPubMed
4.Kakadekar, AP, Hayes, A, Rosenthal, E, Huggon, IC, Baker, EJ, Qureshi, SA, Tynan, M. Balloon atrial septostomy in the intensive care unit under echocardiographic control – nine years experience. Cardiol Young 1992;2: 175–178.CrossRefGoogle Scholar
5.Songswang, J, Aditia, I, Newman, C, Smallhorn, JF, Williams, WG, Freedom, RM. Mortality in potential arterial switch candidates with transposition of the great arteries. J Am Coll Cardiol 1998;32: 753–757.CrossRefGoogle Scholar
6.Tworetzky, W, McElhinney, DB, Brook, MM, Reddy, VM, Hanley, FL, Silverman, NH. Echocardiographic diagnosis alone for the complete repair of major congenital heart defects. J Am Coll Cardiol 1999;33: 228–233.CrossRefGoogle ScholarPubMed
7.Wernovsky, G, Mayer, JE Jr, Jonas, RA, Hanley, FL, Blackstone, EH, Kirklin, JW, Castaneda, AR. Factors influencing early and late outcome of the arterial switch operation for transposition of the great arteries. J Thorac Cardiovasc Surg 1995;109: 289–302CrossRefGoogle ScholarPubMed
8.Tamisier, D, Uoaknine, R, Pouard, P, Mauriat, P, Lefebvre, D, Sidi, D, Vouhe, PR. Neonatal arterial switch operation: coronary artery patterns and coronary events. Eur J Cardio Thorac Surg 1997;11: 810–817.CrossRefGoogle ScholarPubMed
9.Tynan, M.Survival of infants with transposition of the great arteries after balloon atrial septostomy. Lancet 1971;1: 621–623.CrossRefGoogle ScholarPubMed
10.Gutesgell, HP, Garson, A, McNamara, DG. Prognosis for the newborn with transposition of the great arteries. Am J Cardiol 1979;44: 96–100.CrossRefGoogle Scholar
11.Hasan, A, Pozzi, M, Hamilton, JRL. New surgical procedures: can we minimise the learning curve? BMJ 2000;320: 171–173.CrossRefGoogle ScholarPubMed
12.Senate of Surgery. Response to the General Medical Council Determination on the Bristol Case. Royal College of Surgeons of England1998.Google Scholar