Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-16T17:24:41.719Z Has data issue: false hasContentIssue false
  • English
  • Français

Arterial switch operation in patients with transposition and a left-sided aorta

Published online by Cambridge University Press:  11 July 2017

Sachin Talwar ,
Robert H. Anderson ,
Pradeep Ramakrishnan ,
Amolkumar Bhoje ,
Saurabh Gupta ,
Shiv Kumar Choudhary  and
Balram Airan
Sachin Talwar*
Affiliation:
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Robert H. Anderson
Affiliation:
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India Newcastle University of Genetic Medicine, Newcastle-upon-Tyne, United Kingdom
Pradeep Ramakrishnan
Affiliation:
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Amolkumar Bhoje
Affiliation:
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Saurabh Gupta
Affiliation:
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Shiv Kumar Choudhary
Affiliation:
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Balram Airan
Affiliation:
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
*
Correspondence to: Professor S. Talwar, Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi 110029, India. Tel: +91 112 659 4835; Fax: +91 112 658 8663; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

Arterial switch operation is the treatment of choice in infants with transposed arterial trunks. It is technically challenging to perform in patients having usual atrial arrangement and concordant atrioventricular connections but having a left-sided aorta. Correction in this setting requires surgical expertise and precision. Here we review our experience with such patients.

Methods

Between January, 2002 and October, 2013, the arterial switch operation was performed in 20 patients in the combination emphasised above. Patient records were analysed in detail for coronary arterial patterns, and for the techniques used for transfer of the coronary arteries and reconstruction of the great arteries. Outcomes were recorded in terms of in-hospital survival and left ventricular function at the most recent follow-up.

Results

All patients survived the procedure. Ages ranged from 3 days to 18 months, with a median of 75 days; the weight of the patients ranged from 3 to 8.8 kg, with a median of 3.85 kg. The LeCompte manoeuvre was performed in only nine patients. The mean cardiopulmonary bypass time was 157.5±24.9, with a median of 161 minutes, and the mean aortic cross-clamp time was 101.2±23.8, with a median of 102 minutes. Subsequently, two patients died: the first due to a sudden onset of ventricular fibrillation and the second during a crisis of severe pulmonary hypertension. At the last follow-up, which ranged from 23 to 41 months, with a mean of 38.04±2.32 and a median of 38.4 months, all 18 survivors were in NYHA class I, with none requiring cardiac medications and all having normal bi-ventricular function without residual defects.

Conclusion

With appropriate technical modifications, patients with concordant atrioventricular and discordant ventriculo-arterial connections with a left-sided aorta can undergo successful anatomical repair.

Keywords

Discordant ventriculo-arterial connectionsarterial switch operationanatomical repair
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 9 , November 2017 , pp. 1771 - 1777
Check for updates
Copyright
© Cambridge University Press 2017 

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.)

Footnotes

Abstract accepted for presentation at the 7th World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS), Barcelona, Spain, 16–21 July, 2017.

References

1. Baillie, M. The Morbid Anatomy of Some of the More Important Parts of the Human Body, 2nd edn. Johnson and Nicol, London, 1797, p. 38.Google Scholar
2. Farre, JR. Pathological Researches. Essay 1: On Malformations of the Human Heart. Longman, Hurst, Rees, Orme and Brown, London, 1814, p. 28.Google Scholar
3. Becker, AE, Anderson, RH. How should we describe hearts in which the aorta is connected to the right ventricle and the pulmonary trunk to the left ventricle? A matter for reason and logic. Am J Cardiol 1983; 5: 911–912.CrossRefGoogle Scholar
4. Jaggers, JJ, Cameron, DE, Herlong, JR, Ungerleider, RM. Congenital Heart Surgery Nomenclature and Database Project: transposition of the great arteries. Ann Thorac Surg 2000; 69 (Suppl): S205–S235.Google Scholar
5. Houyel, L, Van Praagh, R, Lacour–Gayet, F. Surgery for congenital heart disease: transposition of great arteries (S, D, L) – pathologic anatomy, diagnosis, and surgical management of a newly recognized complex. J Thorac Cardiovasc Surg 1995; 110: 613–624.Google Scholar
6. Jatene, AD, Fontes, VF, Paulista, PP, et al. Successful anatomic correction of transposition of the great vessels. A preliminary report. Arq Bras Cardiol 1975; 28: 461–464.Google Scholar
7. Gittenberger-de Groot, AC, Sauer, U, Oppenheimer-Dekker, A, Quaegebeur, J. Coronary arterial anatomy in transposition of the great arteries: a morphologic study. Pediatr Cardiol 1983; 4 (Suppl 1): 115–124.Google Scholar
8. Van Praagh, R, Ongley, PA, Swan, HJC. Anatomic types of single or common ventricle in man: morphologic and geometric aspects of sixty autopsied cases. Am J Cardiol 1964; 13: 367–386.Google Scholar
9. Van Praagh, R, Van Praagh, S, Vlad, P, Keith, JD. Anatomic types of congenital dextrocardia: diagnostic and embryologic implications. Am J Cardiol 1964; 13: 510–531.CrossRefGoogle Scholar
10. 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
11. Kang, N, de Leval, MR, Elliott, M, et al. Extending the boundaries of the primary arterial switch operation in patients with transposition of the great arteries and intact ventricular septum. Circulation 2004; 110: II-123–II-127.Google Scholar
12. Yacoub, M, Radley Smith, R. Anatomy of the coronary arteries in transposition of the great arteries and methods for their transfer in anatomical correction. Thorax 1978; 33: 418–424.Google Scholar
13. Asou, T, Karl, TR, Rawade, A, Mee, RBB. Arterial switch: translocation of the intramural coronary artery. Ann Thorac Surg 1994; 57: 461–465.CrossRefGoogle ScholarPubMed
14. Sung, SC, Chang, YH, Lee, HD, Kim, S, Woo, JS, Lee, YS. Arterial switch operation for transposition of the great arteries with coronary arteries from a single aortic sinus. Ann Thorac Surg 2005; 80: 636–664.Google Scholar
15. Talwar, S, Shivaprasad, BM, Kothari, SS, Choudhary, SK. A novel conduit-lengthening technique to facilitate the arterial switch operation. Tex Heart Inst J 2009; 36: 234–237.Google Scholar
16. Pasquali, SK, Hasselblad, V, Li, JS, Sanders, SP. Coronary artery pattern and outcome of arterial switch operation for transposition of great arteries: a meta-analysis. Circulation 2002; 106: 2575–2580.Google Scholar
17. Talwar, S, Jha, AJ, Choudhary, SK, Rajashekar, P, Airan, B. Arterial switch operation for transposition of the great arteries with anomalies of cardiac situs and aortic position. J Thorac Cardiovasc Surg 2013; 146: 1553–1556.Google Scholar