Restoring the spiral flow of nature in transposed great arteries.
نویسندگان
چکیده
OBJECTIVES The great arteries are in a non-spiral relationship in their transposition, even after arterial switch operation (ASO) with the Lecompte manoeuvre. We aim to restore the natural spiral great arteries and compare such ASO with conventional ASO with the Lecompte manoeuvre to clarify the functional implications of the spiral great arteries. METHODS The early survivors of ASO (n=130) were included in this retrospective study. In spiral ASO (n=48), the main pulmonary artery ran alongside the aorta and gave rise to its branches posteriorly. Patients who underwent non-spiral ASO with the manoeuvre (n=82) were compared. The survival, re-operation-free ratio and the anatomic details for re-intervention after ASO were reviewed. RESULTS Average follow-up was 5.6 + or - 3.4 years (range: 2 months to 11 years). The estimated 10-year survival was similar (92.6% spiral vs 92.1% non-spiral, respectively). Significant pulmonary stenosis (PS) (>40mmHg) was noted in five (10.4%) in the spiral group and seven patients (9.7%) in the non-spiral (p=NS). The re-operation-free survival at 10 years was not significantly different (87.4% vs 90.1%). The reasons for re-operation were subvalvular PS (n=3) and residual defect (n=2) in the spiral group, while supravalvular PS (n=3), neo-aortic regurgitation (n=1) and aortic neo-coarctation (n=2) in the non-spiral group. Supravalvular PS and aortic neo-coarctation that occurred in the non-spiral group were not seen after spiral ASO. CONCLUSIONS Intermediate-term results of spiral ASO were satisfactory. Transposition is not a mere reversal of the great arteries; therefore, recognition of non-spiral relationship should be appreciated. Spiral reconstruction would be beneficial to reduce supravalvular PS and neo-aortic kinking. Further recognition of spiral function and refined modification might justify the application of spiral ASO in the future.
منابع مشابه
4D flow streamline characteristics of the great arteries twenty years after Lecompte and direct spiral arterial switch operation (DSASO) in simple TGA
Transposition of the great arteries (TGA) is caused by discordance between the great arteries and the ventricles. If left untreated, this anomaly has a disastrous perspective. More recent surgical approach for correction includes the Lecompte technique in which the pulmonary bifurcation is transposed anterior to the aorta, which may be less physiologic. Although the early results are excellent,...
متن کاملNumerical Investigation of Angulation Effects in Stenosed Renal Arteries
Background: Numerical study of angulation effects of renal arteries on blood flow has been of great interest for many researchers.Objective: This paper aims at numerically determining the angulation effects of stenosed renal arteries on blood flow velocity and renal mass flow.Method: An anatomically realistic model of abdominal aorta and renal arteries is reconstructed from CT-scan images and u...
متن کاملRestoration of Transposed Great Arteries With or Without Subpulmonary Obstruction to Nature
متن کامل
Study of Pulsatile Non-Newtonian Blood Flow Through Abdominal Aorta and Renal Arteries Incorporating Fluid- Structure Interaction
Background: The interaction between the blood and the vessel wall is of great clinical interest in studying cardiovascular diseases, the major causes of death in developed countries.Objective: To understand the effects of incorporating fluid-structure interaction into the simulation of blood flow through an anatomically realistic model of abdominal aorta and renal arteries reconstructed from CT...
متن کاملI-6: Remodelling Uterine Spiral Arteries inPregnancy
Background: During the first trimester of pregnancy the uterine spiral arteries that supply blood to the placenta are remodelled, creating heavily dilated conduits lacking maternal vasomotor control. To effect permanent vasodilatation, the internal elastic lamina and medial elastic fibres must be degraded. Failure of remodelling is a key characteristic of the pathological placenta and is though...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
دوره 37 6 شماره
صفحات -
تاریخ انتشار 2010