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. Mortality is higher when there are additional defects like a hole in the heart vsd or narrowing of the arteries to the body aorta. Jun 17, 2009 the arterial switch operation has evolved into the treatment of choice for most forms of transposition of the great arteries tga. Antenatal diagnosis of tga results in better clinical status. Cardiac outcomes in young adult survivors of the arterial.
A 28dayold infant with dtransposition of the great arteries underwent arterial switch operation. Transposition of the great arteries, dtype flash animation, less than 70kb. Arterial switch operation with ventricular septal defect. The arterial switch operation is the most common operation to correct tga as of 2016. Transposition of the great arteries tga the embryo. The aso is considered the standard procedure for correction of tga, with low mortality and. 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. Clinical outcomes after the arterial switch operation for. 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. 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. Objectives we sought to determine cardiac outcomes in young adults with complete transposition of the great arteries tga after the arterial switch operation aso. This operation, called an arterial switch operation, is done within the first few weeks of life. Neonatal arterial switch operation for transposition of the great.
Longterm survival and functional followup in patients. Permanent treatment requires a surgical procedure to switch the arteries to their proper places. Evaluation of a comprehensive cardiovascular magnetic. Arterial switch operation olivier metton, et al european journal of cardiothoracic surgery 37 2010 12461253. Arterial switch operation aso has been optimal for children with transposition of. Daniel tobler adult congenital heart disease university hospital basel. Coronary artery pattern and outcome of arterial switch. This technique minimizes the risk of tension on the anastomosis, facilitates. Transposition of the great arteries, dtype congenital. The difficulty with this operation is the coronary arteries. Adib jatene developed the arterial switch operation in 1975 in sao paulo, brazil. Sep 06, 2016 role of cardiovascular magnetic resonance imaging in postoperative followup after the arterial switch operation for transposition of the great arteries. Recent studies reported convincing results of the aso for tga with an intact ventricular septum in the long term.
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. 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. Tetralogy of fallot tetralogy of fallot is the constellation of four congenital cardiac lesions, including. Transposition of the great arteries or vessels tga tgv. Read at the 94th annual meeting of the american association for thoracic surgery, toronto, ontario, canada, april 2630, 2014. 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. In this surgical operation, the aorta and pulmonary artery are both moved to their normal position.
Clinical guidelines for the management of patients with transposition. The operation is lengthy and requires the surgeon to perform several complex procedures together. Late complications following the arterial switch operation. Atrial septal defect asd atrioventricular septal defect avsd atrium.
The arterial switch operation with ventricular septal defect vsd repair and aortic arch reconstruction is a challenging procedure. In this observational study we aimed to determine the value of a comprehensive cardiovascular magnetic resonance cmr protocol for the detection of coronary. Arrhythmia surgery includes maze arterial switch operation. The arterial switch operation for transposition and complex heart. Late outcomes after arterial switch operation for taussigbing anomaly. 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. The arterial switch operation is currently the preferred surgical approach for complete transposition of the great arteries.
Although the arterial switch is a major surgical procedure, the results are excellent. 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. Extending the boundaries of the primary arterial switch. Late outcomes after arterial switch operation for taussigbing anomaly read at the 94th annual meeting of the american association for thoracic surgery, toronto, ontario, canada, april 2630, 2014. Get a printable copy pdf file of the complete article 1. The coronary pattern was yacoub type a, in which coronary transfer is usually thought to be easy. The arterial switch procedure requires cardiopulmonary bypass and aortic cross clamping. Identify any rvot obstruction, neopulmonary valve stenosis or supravalvar ps. Arterial switch procedure radiology reference article. 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. Longterm fate of the aortic valve after an arterial switch. Ninetynine percent of the surgeries are successful. Morbidity of the arterial switch operation request pdf.
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. Late arterial switch surgery under ecmo support in a patient with. Transposition of the great arteries 0 university of chicago. 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. Arterial switch operation aso was performed in the light of. Jones, md,a natasha khan, md,a paul clift, md,b william j. Postoperative complications and their management after. Implications of early aortic stiffening in patients with. After these efforts, informationwasstill notobtainedduringthis followupin 26 patients not known to be dead. What is measured in this report and why are these measures important. Arterial switch operation presented during the 3rd african association of cardiovascular and thoracic surgery training at the college of health sciences, university of nairobi. It is for this reason that the operation is performed in the newborn period. Definition of transposition of the great arteries healthzene.
Pdf the atrial switch operation was developed by the efforts of many surgeons, with the most notable contributions made by blalock, hanlon, albert. It focuses on simple transposition isolated ventriculoarterial discordance or dtga with some references to transposition with a ventricular septal defect vsd. Adaptable pulmonary artery band for late arterial switch. 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. Our study aimed to examine longterm outcomes after aso for. T1 late complications following the arterial switch operation. Meijboom, md, and stefano di bernardo, md department of pediatric cardiology and department of cardiovascular surgery, university hospital, lausanne, switzerland. 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 arterial switch operation has evolved into the treatment of choice for most forms of transposition of the great arteries tga.
Late outcomes after arterial switch operation for taussig. 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. 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. Jun 07, 2012 the arterial switch operation is a simple concept. Transposition of the great arteries tga is a cyanotic congenital heart defect in. Longterm outcomes after an arterial switch operation for.
Article information, pdf download for the arterial switch operation in. The aorta and pulmonary artery are connected to the correct lower chambers of the heart in this surgery. Expanding the boundaries of the primary arterial switch operation. The arterial switch procedure is a technically reproducible operation. 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. 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. 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. Medications might be needed after surgery to help the heart pump better, control blood pressure, help get rid of extra fluid in the. N2 the arterial switch operation has been the principal treatment for transposition of the great arteries and its variants for the last 25 years. 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.
Theage at operation was arterial switch repair, 72% had the left anterior descending and circumflex. The increasing difficulties of the arterial switch operation in tgadorvvsd are. 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. Arterial switch operation or arterial switch, is an open heart surgical procedure used to correct dextrotransposition of the great arteries dtga. The operation was the first to realign the vessels incorrect anatomical position. Patients with tga and a small vsd undergo aso and vsd repair.
It is an openheart procedure that requires a temporary stopping of the babys heart while a heartlung machine handles respiration and blood circulation. There is also another, less common, surgery called an atrial switch operation. Pediatric cardiothoracic surgery arterial switch operation. The aorta and the pulmonary artery are transected above the valves, moved to the correct position, and sewn in place. Arterial switch operation longterm outcomes all good. 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. This operation will require the use of cardiopulmonary bypass heartlung machine. Complete transposition of the great arteries is a congenital cardiac anomaly in which the aorta arises from the morphological right ventricle, and the pulmonary. Between september 1995 and january 2014, 128 consecutive arterial switch operations were performed. Transposition of the great arteries tga arterial switch operation aso jatene operation. After these efforts, informationwasstill notobtainedduringthis followupin 26. The arterial switch procedure is usually performed in the first two weeks of life.
Any other heart defects present such as an asd or vsd may also be needed to restore normal blood flow. 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. We sought to determine the midterm results of this intervention. 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. Adaptable pulmonary artery band for late arterial switch procedure in transposition of the great arteries nicole sekarski, md, michel hurni, md, ludwig k. Kirklin et al riskfactors in arterial switch operation for transposition 1503 was received within 3 weeks, strenuous attempts were madetolocateandinterrogate,bytelephone,thefamily orotherresponsible persons.
The arterial switch operation aso represents a remarkable success story in the surgical treatment of cyanotic congenital heart disease. The arterial switch operation aso is the procedure of choice for treatment of most forms of transposition of the great arteries tga. Longterm outcomes of the arterial switch operation for. We report here our experience with retraining of the lv in latediagnosed tga with the adaptable pab and com.
Pdf arterial switch operation for transposition of great arteries. Coronary artery pattern and outcome of arterial switch operation for transposition of great arteries a metaanalysis sara k. Are there indications for atrial switch or atrial inversion. The society of thoracic surgeons sts congenital heart surgery database shows an expected outcome of 1. 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. That surgery lasted until 1998 when it was replaced with the arterial switch operation.
Tm an arterial switch operation was performed in 514 of the 846 patients one additional operation since the last report 4 with either simple tga n 452 or tga and ventricular septal defect vsd n 62 and form the study group. Role of cardiovascular magnetic resonance imaging in postoperative followup after the arterial switch operation for transposition of the great arteries. Role of cardiovascular magnetic resonance imaging in. Longterm fate of the aortic valve after an arterial. 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. Outcomes of patients after arterial switch operation. Surgical mortality during this period was analyzed retrospectively.
Mdfrom the department of radiology, leiden university medical center, the netherlands. Transposition of the great arteries the patient guide to. Neonatal arterial switch operation for transposition of the great arteries in a patient with mirror image dextrocardia and situs inversus totalis. Current expectations for newborns undergoing the arterial. Arterial switch operation and complex coronary patterns. 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. Intramural coronary arteries and outcome of neonatal arterial switch operation olivier metton, et al european journal of cardiothoracic surgery 37 2010 12461253. An arterial switch operation is an openheart procedure. 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. Pdf complete transposition of the great arteries tga accountsfor 5% to 7% of congenital cardiac anomalies, and representsthe second. The modern repair that is preferred is called the arterial switch operation aso for short.
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