INTRODUCTION

Arterial switch operation is the preferred surgical management for d-transposition of the great arteries, but it still has long-term complications, which necessitate continued follow-up of patients. This procedure was first performed in this institution in 1991, and after three decades, there is a need to evaluate midterm and long-term outcomes in this population.

METHODS

This is a descriptive study on arterial switch operation patients between January 2010 and March 2019 in this institution. The following parameters were collected through review of charts and online health records (Medtrack): preoperative clinical data, surgical technique and immediate postoperative course and complications, echocardiographic results, and current clinical status. The study was approved by the institutional ethics review board of the hospital.

RESULTS

Among the 108 patients included in the study, 35 were long-term patients, and 73 were midterm. A total of 27 patients (25%) were lost to follow-up. Among the remaining patients (n = 81), 76 (94%) were alive. The most common postoperative complications were pulmonary stenosis (n = 11), aortic regurgitation (n = 24), and aortic dilatation (n = 2). One patient had reintervention after surgery for severe pulmonic stenosis. Overall survival function was 93.7% after 5 years (95% confidence interval, 0.81-0.98) and 79.4% after 9 years (95% confidence interval, 0.46-0.93).

CONCLUSION

Complications seen in this population are similar to those seen in literature. The overall survival rate after 5 years compares to those of other institutions. However, long-term survival rates were lower, which may be due to poor patient follow-up and a high rate of patient attrition over time. To improve future outcomes, strategies should be implemented to promote continuity of care, and parents should be advised regarding the importance of follow-up.

Arterial Switch Operation ; Echocardiography ; Survival Rate

Neo-aortic insufficiency associated with root enlargement following an arterial switch operation is a serious late complication. To achieve successful surgical correction of this condition, multiple factors should be considered, including the individual patient's anatomy, the challenging nature of the redo procedure, and the patient's young age. However, limited publications have described the use of valve-sparing techniques for the treatment of neo-aortic insufficiency associated with root enlargement following an arterial switch operation. Herein, we report our recent experience of a valve-sparing aortic root procedure with ascending aorta and hemiarch replacement despite the presence of a discrepancy in leaflet size and nearby severe adhesions.
Aorta ; Arterial Switch Operation* ; Coronary Stenosis ; Humans ; Reoperation ; Replantation*

INTRODUCTION

Ductal stenting can be a nonsurgical option and less morbid method to provide pressure and volume overload to the regressing left ventricle in late presenters of transposition of the great arteries, intact ventricular septum (TGA-IVS), prior to arterial switch operation (ASO).

CASE PRESENTATION

This is a case of an infant diagnosed with TGA-IVS beyond the neonatal period who underwent balloon atrial septostomy and ductal stenting to retrain involuted left ventricle prior to definitive ASO.

DISCUSSION

Ductal stenting is an alternative option in late presenters of transposition of the great arteries with involuted left ventricle. It provides volume loading and, to a lesser extent, pressure loading leading to left ventricular hypertrophy. Also, presence of the stented duct allows improved oxygenation eliminating the need for aortopulmonary shunt. It can be a less morbid method of left ventricular training because it avoids hemodynamic stress, pulmonary artery distortion, and neoaortic valve regurgitation.

CONCLUSION

Ductal stenting in late presenters with TGA-IVS successfully retrains the left ventricle and achieves safe late ASO.

Heart Defects, Congenital ; Transposition of Great Vessels ; Arterial Switch Operation

No abstract available.
Arterial Switch Operation* ; Arteries* ; Catheter Ablation* ; Catheters* ; Double Outlet Right Ventricle* ; Humans ; Tachycardia, Ventricular*

We report a case of high-output chylothorax associated with thrombo-occlusion of the superior vena cava (SVC) and left innominate vein (LIV) following an arterial switch operation in a neonate. The chylothorax was resolved by 3 weeks after surgical reconstruction of the SVC and LIV using fresh autologous pericardium. We confirmed the patency of the SVC and LIV with a 1-year follow-up computed tomographic scan at our outpatient clinic.
Ambulatory Care Facilities ; Arterial Switch Operation ; Brachiocephalic Veins* ; Chylothorax* ; Follow-Up Studies ; Humans ; Infant, Newborn* ; Pericardium ; Thrombosis ; Vena Cava, Superior*

Double outlet right ventricle (DORV) and transposition of the great arteries (TGA) with ventricular septal defect (VSD) and pulmonary stenosis (PS) are complex heart diseases, the treatment of which remains a surgical challenge. The Rastelli procedure is still the most commonly performed treatment. Aortic root translocation including an arterial switch operation is advantageous anatomically since it has a lower possibility of conduit blockage and the left ventricle outflow tract remains straight. This study reports successful aortic root transpositions in two patients, one with DORV with VSD and PS and one with TGA with VSD and PS. Both patients were discharged without postoperative complications.
Arterial Switch Operation ; Arteries* ; Double Outlet Right Ventricle* ; Heart Diseases ; Heart Septal Defects, Ventricular* ; Heart Ventricles ; Humans ; Postoperative Complications ; Pulmonary Valve Stenosis*

Adult ; Arterial Switch Operation ; Atrial Flutter ; physiopathology ; surgery ; Catheter Ablation ; Humans ; Male ; Postoperative Complications ; Tricuspid Valve ; surgery ; Vena Cava, Superior ; surgery

An abnormal myocardial perfusion is not uncommon in congenital heart defects (CHD). Many case reports and prospective studies were done describing myocardial peOision scintigraphy (MPS)findings after an arterial switch operation (ASO) among transposition of the great arteries (TCA), but to the best of the authors' knowledge, none have cited MPS findings in the immediate post-operative petiod. This paper aims to show two ckfferent clinicalthuatiomts in which (MPS) was used in the assessment of myocarchalfiinction in TCA immediatelyfollowing an arterial switch operation. Two male infants; aged 2 months and 4 months; both diagnosed with transposition of the great arteries presenting with past-operative morbidities after an arterial switch operation were referred to the Department of Nuclear Medicine/or evaluation. The younger infant was ditty discharged improved with an earlier magical intervention in contrast to the other who expired Bothpatients revealed a scintigraphic picture of myocarcbal ischemia and left ventricular a54ifiniction with concomitant right ventricular hypertrophy MPS .findings and reflective clinical pictures of patients with corrected congenital disease are yet to be/illy elticidated,.from the expected natural course after the stag/Cal intervention and long term complications ofsuch cases. The two cases present an invaluable avenue of non-invasive diagnostic modality using-MPS to assess probable pathologic mechanisms that occur after an arterial switch operation, and perhaps suggest incremental value not only in the post-operative period but in the preoperative scenario in the prognostication of these patients.

Human ; Male ; Female ; Adult ; Infant ; Hypertrophy, Right Ventricular ; Transposition Of Great Vessels ; Arterial Switch Operation ; Myocardial Perfusion Imaging ; Heart Defects, Congenital ; Heart Ventricles

An abnormal myocardial perfusion is not uncommon in congenital heart defects (CHD). Many case reports and prospective studies were done describing myocardial peOision scintigraphy (MPS)findings after an arterial switch operation (ASO) among transposition of the great arteries (TCA), but to the best of the authors' knowledge, none have cited MPS findings in the immediate post-operative petiod. This paper aims to show two ckfferent clinicalthuatiomts in which (MPS) was used in the assessment of myocarchalfiinction in TCA immediatelyfollowing an arterial switch operation. Two male infants; aged 2 months and 4 months; both diagnosed with transposition of the great arteries presenting with past-operative morbidities after an arterial switch operation were referred to the Department of Nuclear Medicine/or evaluation. The younger infant was ditty discharged improved with an earlier magical intervention in contrast to the other who expired Bothpatients revealed a scintigraphic picture of myocarcbal ischemia and left ventricular a54ifiniction with concomitant right ventricular hypertrophy MPS .findings and reflective clinical pictures of patients with corrected congenital disease are yet to be/illy elticidated,.from the expected natural course after the stag/Cal intervention and long term complications ofsuch cases. The two cases present an invaluable avenue of non-invasive diagnostic modality using-MPS to assess probable pathologic mechanisms that occur after an arterial switch operation, and perhaps suggest incremental value not only in the post-operative period but in the preoperative scenario in the prognostication of these patients.

Human ; Male ; Female ; Adult ; Infant ; Hypertrophy, Right Ventricular ; Transposition Of Great Vessels ; Arterial Switch Operation ; Myocardial Perfusion Imaging ; Heart Defects, Congenital ; Heart Ventricles

BACKGROUND AND OBJECTIVES: The aims of this study were to determine the early and late outcomes of anatomic repair of congenitally corrected transposition of the great arteries (ccTGA) and to evaluate effectiveness of the hemi-Mustard procedure. SUBJECTS AND METHODS: We conducted a retrospective, single-center study of patients who underwent anatomic repair for ccTGA between July 1996 and December 2013. Sixteen patients were included in the study. The median age at the time of the operation was 3.5 years (range: 0.5-29.7), and the median body weight was 13.3 kg (range: 5.8-54). The median follow-up duration was 7.7 years (range: 0.2-17.4). RESULTS: Atrial switch was achieved using the Mustard procedure in 12 patients (hemi-Mustard procedure in 11) or the Senning procedure in four patients. The ventriculoarterial procedure was performed using the Rastelli procedure in 11 patients and arterial switch in five patients. Six patients underwent tricuspid valvuloplasty. The survival rate was 93.8±6.1%. The rate of freedom from reoperation at 5 years was 92.3±7.4% in the Rastelli group. All patients except one were New York Heart Association class I. All patients except one had mild tricuspid regurgitation. CONCLUSION: Anatomic repair can be performed with a low risk of in-hospital mortality. The hemi-Mustard strategy for selected patients is one solution for reducing early mortality and morbidity, and long-term complications such as venous pathway stenosis or sinus node dysfunction.
Arterial Switch Operation ; Arteries* ; Body Weight ; Constriction, Pathologic ; Follow-Up Studies ; Freedom ; Heart ; Heart Defects, Congenital ; Hospital Mortality ; Humans ; Mortality ; Reoperation ; Retrospective Studies ; Sick Sinus Syndrome ; Survival Rate ; Tricuspid Valve Insufficiency