Criteria for two-staged arterial switch operation for simple transposition of great arteries.
نویسندگان
چکیده
We analyzed hemodynamic variables in patients with transposition of the great arteries with intact ventricular septum (simple transposition) after pulmonary artery banding and Blalock-Taussig anastomosis to establish the criteria for two-staged arterial switch operation. The study included 35 patients who underwent the switch operation after banding and anastomosis; two died shortly after surgery, and one died of tachycardia 31 days after the operation. The left-to-right ventricular pressure ratio was above 0.83 in all surviving patients, 0.68 and 0.63 in the two operative deaths, and 0.84 in the other death. In the 32 surviving patients, angiographically determined left ventricular (LV) end-diastolic volume and ejection fraction averaged 147 +/- 46(SD)% of normal and 0.64 +/- 0.12, respectively. We also measured LV mass using angiographic LV semiaxes and end-diastolic LV posterior wall thickness obtained from an echocardiogram. These variables of the patients who died were not different from those of the surviving patients. The wall thickness was greater than 4 mm in the surviving patients, while it was 3.5 mm in the two patients who died early and 5 mm in the patient who died later. From the semiaxes, the wall thickness, and aortic diastolic pressure, all of which were obtained before the anatomic repair, we calculated the predictive LV wall stress. This wall stress would indicate the LV wall stress at the time of aortic valve opening immediately after the arterial switch operation. Predictive wall stress was less than 120 x 10(3) dynes/cm2 in all but one of the surviving patients, whereas it was 151, 153, and 186 x 10(3) dynes/cm2 in the three patients who died.(ABSTRACT TRUNCATED AT 250 WORDS)
منابع مشابه
Factors influencing choice of procedure in transposition of the great arteries: a decision analysis approach.
Clinicians have a difficult choice between the arterial switch (Jatene et al.) and the atrial baffle operation (Mustard or Senning) for transposition of the great arteries. The surgical decision is essentially a determination of whether the long-term course after the arterial switch procedure (thought to be more favorable than after the atrial baffle procedure) plus elimination of presurgical a...
متن کاملTransposition of Great Arteries with Intramural Coronary Artery: Experience with a Modified Surgical Technique
OBJECTIVE Transposition of the great arteries is a common congenital heart disease. Arterial switch is the gold standard operation for this complex heart disease. Arterial switch operation in the presence of intramural coronary artery is surgically the most demanding even for the most experienced hands. We are presenting our experience with a modified technique for intramural coronary arteries ...
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Cardiovascular magnetic resonance (MR) plays a major role in the evaluation of patients with transposition of the great arteries, especially during follow-up after surgical intervention such as the arterial switch operation (ASO). It is recommended in recent guidelines that cardiovascular MR should be integrated in the routine evaluation of all postoperative patients with transposition of the g...
متن کاملRole of Cardiovascular Magnetic Resonance Imaging in Postoperative Follow-Up After the Arterial Switch Operation for Transposition of the Great Arteries.
Cardiovascular magnetic resonance (MR) plays a major role in the evaluation of patients with transposition of the great arteries, especially during follow-up after surgical intervention such as the arterial switch operation (ASO). It is recommended in recent guidelines that cardiovascular MR should be integrated in the routine evaluation of all postoperative patients with transposition of the g...
متن کاملRole of Cardiovascular Magnetic Resonance Imaging in Postoperative Follow-Up After the Arterial Switch Operation for Transposition of the Great Arteries
Cardiovascular magnetic resonance (MR) plays a major role in the evaluation of patients with transposition of the great arteries, especially during follow-up after surgical intervention such as the arterial switch operation (ASO). It is recommended in recent guidelines that cardiovascular MR should be integrated in the routine evaluation of all postoperative patients with transposition of the g...
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ورودعنوان ژورنال:
- Circulation
دوره 78 1 شماره
صفحات -
تاریخ انتشار 1988