Late arterial switch surgery under ecmo support in a patient with. The modern repair that is preferred is called the arterial switch operation aso for short. T1 late complications following the arterial switch operation. Medications might be needed after surgery to help the heart pump better, control blood pressure, help get rid of extra fluid in the.
After these efforts, informationwasstill notobtainedduringthis followupin 26 patients not known to be dead. Dtransposition of the great vessels is a congenital cardiac anomaly in which the aorta arises from the right ventricle, and the pulmonary artery arises from the left ventricle. Arterial switch operation longterm outcomes all good. That surgery lasted until 1998 when it was replaced with the arterial switch operation. The arterial switch procedure is usually performed in the first two weeks of life. The arterial switch procedure is a technically reproducible operation. Transposition of the great arteries tga arterial switch operation aso jatene operation.
It focuses on simple transposition isolated ventriculoarterial discordance or dtga with some references to transposition with a ventricular septal defect vsd. After these efforts, informationwasstill notobtainedduringthis followupin 26. What is measured in this report and why are these measures important. It is an openheart procedure that requires a temporary stopping of the babys heart while a heartlung machine handles respiration and blood circulation. Jones, md,a natasha khan, md,a paul clift, md,b william j.
The aorta and pulmonary artery are connected to the correct lower chambers of the heart in this surgery. Longterm fate of the aortic valve after an arterial switch. Longterm survival and functional followup in patients after the arterial switch operation felix haas, md, michael wottke, md, holger poppert, and hans meisner, md department of cardiovascular surgery, german heart center of munich, munich, germany. Author links open overlay panel mathieu vergnat md a albanelouen baruteau md a b lucile houyel md a mohamedou ly md a regine roussin md a andre. The coronary pattern was yacoub type a, in which coronary transfer is usually thought to be easy. Clinical outcomes after the arterial switch operation for. The arterial switch operation with ventricular septal defect vsd repair and aortic arch reconstruction is a challenging procedure. This operation will require the use of cardiopulmonary bypass heartlung machine. The aorta and the pulmonary artery are transected above the valves, moved to the correct position, and sewn in place. Permanent treatment requires a surgical procedure to switch the arteries to their proper places.
This study is designed to assess recent outcomes after the aso in babies presenting with transposition of the great arteries tga and taussigbing anomaly tba. Adib jatene developed the arterial switch operation in 1975 in sao paulo, brazil. Backgroundthe elastic function of the aorta in patients with transposition of the great arteries after arterial switch operation aso is suspected to be important for longterm prognosis. A 28dayold infant with dtransposition of the great arteries underwent arterial switch operation. Longterm outcomes after an arterial switch operation for. Arterial switch operation or arterial switch, is an open heart surgical procedure used to correct dextrotransposition of the great arteries dtga. Aorta repair, arterial switch operation, ventricular septal defect repair, arterial switch operation and ventricular septal defect repair, norwood procedure, glennhemifontan, fontan, truncus repair, complete atrioventricular canal repair, and tetralogy of fallot repair. The society of thoracic surgeons sts congenital heart surgery database shows an expected outcome of 1. The arterial switch operation is currently the preferred surgical approach for complete transposition of the great arteries.
It is for this reason that the operation is performed in the newborn period while the left ventricle remains adequately prepared to support the systemic circulation. Arterial switch operation presented during the 3rd african association of cardiovascular and thoracic surgery training at the college of health sciences, university of nairobi. Surgical mortality during this period was analyzed retrospectively. Postoperative complications and their management after arterial switch operation in infants with transposition of great arteries lixing zhu, linhua tan, xiaojun he, caiyun zhang, yanping yu, zewei zhang hangzhou, china background. The operation was the first to realign the vessels incorrect anatomical position. Jun 07, 2012 the arterial switch operation is a simple concept. Although the arterial switch is a major surgical procedure, the results are excellent. This video shows the repair of a newborn with transposition of the great arteries and ventricular septal defect by means of arterial switch and vsd closure. The arterial switch procedure requires cardiopulmonary bypass and aortic cross clamping. Transposition of the great arteries, dtype congenital. Expanding the boundaries of the primary arterial switch operation. Clinical guidelines for the management of patients with transposition. Arterial switch operation aso has been optimal for children with transposition of.
N2 the arterial switch operation has been the principal treatment for transposition of the great arteries and its variants for the last 25 years. An arterial switch operation is an openheart procedure. Neonatal arterial switch operation for transposition of the great. Any other heart defects present such as an asd or vsd may also be needed to restore normal blood flow. Adaptable pulmonary artery band for late arterial switch procedure in transposition of the great arteries nicole sekarski, md, michel hurni, md, ludwig k. Coronary artery pattern and outcome of arterial switch operation for transposition of great arteries a metaanalysis sara k. This operation, called an arterial switch operation, is done within the first few weeks of life.
The increasing difficulties of the arterial switch operation in tgadorvvsd are. Recent studies reported convincing results of the aso for tga with an intact ventricular septum in the long term. The arterial switch procedure, also known as the jatene switch procedure, is an intervention designed to correct dtransposition of the great arteries dtga at the level of the aorta and main pulmonary artery. Background although cardiac outcomes in the pediatric population with tga after aso have been well described, outcomes in the adult population have not to our knowledge been studied. Although coronary artery obstruction, aortic insufficiency ai, and pulmonary stenosis ps have been reported after arterial switch operation aso, limited longterm studies on aso exist. Coronary artery pattern and outcome of arterial switch. Ithink that the arterial switcha real anatomical correctionwill be the goldenstandardin the near future and that the atrial switch will be used only for the few patients who are not suitable candidates for the arterial switch ann thorac surg 2004. Arterial switch operation, which is another common and effective surgical procedure, is usually most often performed during the infants early months of his or her life.
The operation is lengthy and requires the surgeon to perform several complex procedures together. Morbidity of the arterial switch operation request pdf. Role of cardiovascular magnetic resonance imaging in. Implications of early aortic stiffening in patients with. Daniel tobler adult congenital heart disease university hospital basel. The objective of this paper was to describe the outcomes in patients submitted to arterial switch operation and to analyze the predictors of inhospital mortality and further need of reoperation at a singlecenter institution. Patients with tga and a small vsd undergo aso and vsd repair. Jan 06, 2017 this video shows the repair of a newborn with transposition of the great arteries and ventricular septal defect by means of arterial switch and vsd closure. Postoperative complications and their management after. In this observational study we aimed to determine the value of a comprehensive cardiovascular magnetic resonance cmr protocol for the detection of coronary. Pediatric cardiothoracic surgery arterial switch operation. Pdf the atrial switch operation was developed by the efforts of many surgeons, with the most notable contributions made by blalock, hanlon, albert.
There is also another, less common, surgery called an atrial switch operation. Antenatal diagnosis of tga results in better clinical status. The aso remains a major, complex cardiac operation that is performed in the first few weeks of life and requires surgeons specifically trained in such newborn repairs. Patients are transferred on high fio2, with a manual resusci. The difficulty with this operation is the coronary arteries. In this surgical operation, the aorta and pulmonary artery are both moved to their normal position. Forbess, md a t childrens medical center dallas, the arterial switch operation is routinely performed with bicaval cannulation, continuous cardiopulmonary bypass cpb, and moderate hypothermia of 25 to 28c. Longterm fate of the aortic valve after an arterial. Tetralogy of fallot tetralogy of fallot is the constellation of four congenital cardiac lesions, including. Arterial switch procedure radiology reference article. We sought to determine the midterm results of this intervention. This technique minimizes the risk of tension on the anastomosis, facilitates.
Longterm fate of the aortic valve after an arterial switch operation mauro lo rito, md,a mario fittipaldi, md,a randula haththotuwa, md,b timothy j. The arterial switch operation is the most common operation to correct tga as of 2016. Transposition of the great arteries, dtype flash animation, less than 70kb. The arterial switch operation aso represents a remarkable success story in the surgical treatment of cyanotic congenital heart disease. Transposition of the great arteries tga is a cyanotic congenital heart defect in. Transposition of the great arteries the patient guide to. Recently reported opera despite advancement in the technical aspects of the procedure, certain anatomical variations of the coronary arteries, such as a single coronary orifice andor intramural coronary artery.
Arterial switch operation olivier metton, et al european journal of cardiothoracic surgery 37 2010 12461253. Definition of transposition of the great arteries healthzene. Oct 26, 2015 arterial switch operation presented during the 3rd african association of cardiovascular and thoracic surgery training at the college of health sciences, university of nairobi. Jun 17, 2009 the arterial switch operation has evolved into the treatment of choice for most forms of transposition of the great arteries tga. It is for this reason that the operation is performed in the newborn period. When the infant is about one week old, an arterial switch operation is performed which corrects the defect by connecting the aorta to the left ventricle and the pulmonary artery to the right ventricle, as in a. Late outcomes after arterial switch operation for taussig. Adaptable pulmonary artery band for late arterial switch. Meijboom, md, and stefano di bernardo, md department of pediatric cardiology and department of cardiovascular surgery, university hospital, lausanne, switzerland. The arterial switch operation has evolved into the treatment of choice for most forms of transposition of the great arteries tga. The aso is considered the standard procedure for correction of tga, with low mortality and. Kirklin et al riskfactors in arterial switch operation for transposition 1503 was received within 3 weeks, strenuous attempts were madetolocateandinterrogate,bytelephone,thefamily orotherresponsible persons. Longterm outcomes of the arterial switch operation for. Pdf complete transposition of the great arteries tga accountsfor 5% to 7% of congenital cardiac anomalies, and representsthe second.
Transposition of the great arteries or vessels tga tgv. Mdfrom the department of radiology, leiden university medical center, the netherlands. Ninetynine percent of the surgeries are successful. Complete transposition of the great arteries is a congenital cardiac anomaly in which the aorta arises from the morphological right ventricle, and the pulmonary. Transposition of the great arteries tga the embryo. Closed coronary artery transfer during the arterial switch operation for transposition of the great arteries is a reliable and safe method that facilitates precise transfer of the coronary buttons into the neoaortic root. Neonatal arterial switch operation for transposition of the great arteries in a patient with mirror image dextrocardia and situs inversus totalis. Tga tgv is most commonly repaired with a surgical procedure called an arterial switch operation aorta and pulmonary artery are switched so that the aorta and pulmonary artery are connected to the correct ventricles. Late complications following the arterial switch operation.
It is used to correct many forms of transposition of the great arteries, a congenital heart defect in which the aorta and the pulmonary artery are reversed. Objectives we sought to determine cardiac outcomes in young adults with complete transposition of the great arteries tga after the arterial switch operation aso. Are there indications for atrial switch or atrial inversion. Identify any rvot obstruction, neopulmonary valve stenosis or supravalvar ps. Arterial switch operation aso was performed in the light of. Evaluation of a comprehensive cardiovascular magnetic. Longterm survival and functional followup in patients. Transposition of the great arteries 0 university of chicago. Backgroundwe have previously suggested that the primary arterial switch operation is a feasible strategy for patients with transposition of the great arteries and intact ventricular septum tgaivs up to age 2 months. Between september 1995 and january 2014, 128 consecutive arterial switch operations were performed.
Atrial septal defect asd atrioventricular septal defect avsd atrium. In adults with prior arterial switch operation aso for dtransposition of the great arteries, the need for routine coronary artery assessment and evaluation for silent myocardial ischemia is not well defined. When the infant is about one week old, an arterial switch operation is performed which corrects the defect by connecting the aorta to the left ventricle and the pulmonary artery to the right ventricle, as in a normal heart see animation at right. Pdf arterial switch operation for transposition of great arteries.
The arterial switch operation for transposition and complex heart. Arterial switch operation and complex coronary patterns. Get a printable copy pdf file of the complete article 1. Theage at operation was arterial switch repair, 72% had the left anterior descending and circumflex. Our study aimed to examine longterm outcomes after aso for. Arrhythmia surgery includes maze arterial switch operation. Article information, pdf download for the arterial switch operation in. Read at the 94th annual meeting of the american association for thoracic surgery, toronto, ontario, canada, april 2630, 2014. We report here our experience with retraining of the lv in latediagnosed tga with the adaptable pab and com. Role of cardiovascular magnetic resonance imaging in postoperative followup after the arterial switch operation for transposition of the great arteries. Sep 06, 2016 role of cardiovascular magnetic resonance imaging in postoperative followup after the arterial switch operation for transposition of the great arteries.
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