Late arterial switch surgery under ecmo support in a patient with. The aorta and pulmonary artery are connected to the correct lower chambers of the heart in this surgery. Although the arterial switch is a major surgical procedure, the results are excellent. Transposition of the great arteries tga the embryo. The arterial switch operation aso represents a remarkable success story in the surgical treatment of cyanotic congenital heart disease. Coronary artery pattern and outcome of arterial switch operation for transposition of great arteries a metaanalysis sara k.
It focuses on simple transposition isolated ventriculoarterial discordance or dtga with some references to transposition with a ventricular septal defect vsd. N2 the arterial switch operation has been the principal treatment for transposition of the great arteries and its variants for the last 25 years. 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. 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. Patients are transferred on high fio2, with a manual resusci. The arterial switch procedure is a technically reproducible operation. 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. The increasing difficulties of the arterial switch operation in tgadorvvsd are. Outcomes of patients after 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. Evaluation of a comprehensive cardiovascular magnetic. Objectives we sought to determine cardiac outcomes in young adults with complete transposition of the great arteries tga after the arterial switch operation aso. Arterial switch procedure radiology reference article.
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. There is also another, less common, surgery called an atrial switch operation. Transposition of the great arteries tga arterial switch operation aso jatene operation. Adaptable pulmonary artery band for late arterial switch procedure in transposition of the great arteries nicole sekarski, md, michel hurni, md, ludwig k. Any other heart defects present such as an asd or vsd may also be needed to restore normal blood flow. Coronary artery pattern and outcome of arterial switch. This operation, called an arterial switch operation, is done within the first few weeks of life.
After these efforts, informationwasstill notobtainedduringthis followupin 26 patients not known to be dead. Arterial switch operation olivier metton, et al european journal of cardiothoracic surgery 37 2010 12461253. The arterial switch operation with ventricular septal defect vsd repair and aortic arch reconstruction is a challenging procedure. Neonatal arterial switch operation for transposition of the great. 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 the patient guide to. Pdf the atrial switch operation was developed by the efforts of many surgeons, with the most notable contributions made by blalock, hanlon, albert. Transposition of the great arteries or vessels tga tgv. Arterial switch operation and complex coronary patterns.
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. Atrial septal defect asd atrioventricular septal defect avsd atrium. Clinical guidelines for the management of patients with transposition. The arterial switch procedure is usually performed in the first two weeks of life. Pdf arterial switch operation for transposition of great arteries. The arterial switch operation is currently the preferred surgical approach for complete transposition of the great arteries. This technique minimizes the risk of tension on the anastomosis, facilitates. The arterial switch operation for transposition and complex heart. 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. That surgery lasted until 1998 when it was replaced with the arterial switch operation. Arrhythmia surgery includes maze arterial switch operation. Definition of transposition of the great arteries healthzene.
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. 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. Neonatal arterial switch operation for transposition of the great arteries in a patient with mirror image dextrocardia and situs inversus totalis. Arterial switch operation longterm outcomes all good. 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. Postoperative complications and their management after. Patients with tga and a small vsd undergo aso and vsd repair. The arterial switch operation aso is the procedure of choice for treatment of most forms of transposition of the great arteries tga. 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. 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. Transposition of the great arteries 0 university of chicago. Antenatal diagnosis of tga results in better clinical status. The arterial switch operation has evolved into the treatment of choice for most forms of transposition of the great arteries tga.
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. 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. Cardiac outcomes in young adult survivors of the arterial. 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. Late complications following the arterial switch operation. 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. 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. Mdfrom the department of radiology, leiden university medical center, the netherlands. Implications of early aortic stiffening in patients with. Adaptable pulmonary artery band for late arterial switch. Morbidity of the arterial switch operation request pdf. Between september 1995 and january 2014, 128 consecutive arterial switch operations were performed.
Jun 07, 2012 the arterial switch operation is a simple concept. Clinical outcomes after the arterial switch operation for. Transposition of the great arteries, dtype flash animation, less than 70kb. 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. 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. We report here our experience with retraining of the lv in latediagnosed tga with the adaptable pab and com. Longterm survival and functional followup in patients. Arterial switch operation or arterial switch, is an open heart surgical procedure used to correct dextrotransposition of the great arteries dtga. Pdf complete transposition of the great arteries tga accountsfor 5% to 7% of congenital cardiac anomalies, and representsthe second. Identify any rvot obstruction, neopulmonary valve stenosis or supravalvar ps.
Our study aimed to examine longterm outcomes after aso for. Kirklin et al riskfactors in arterial switch operation for transposition 1503 was received within 3 weeks, strenuous attempts were madetolocateandinterrogate,bytelephone,thefamily orotherresponsible persons. Recent studies reported convincing results of the aso for tga with an intact ventricular septum in the long term. Transposition of the great arteries, dtype congenital. In this surgical operation, the aorta and pulmonary artery are both moved to their normal position. Extending the boundaries of the primary arterial switch. The arterial switch operation is the most common operation to correct tga as of 2016. Tetralogy of fallot tetralogy of fallot is the constellation of four congenital cardiac lesions, including.
Get a printable copy pdf file of the complete article 1. Late outcomes after arterial switch operation for taussig. A 28dayold infant with dtransposition of the great arteries underwent arterial switch operation. Permanent treatment requires a surgical procedure to switch the arteries to their proper places.
Arterial switch operation aso was performed in the light of. 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. An arterial switch operation is an openheart procedure. 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. The arterial switch procedure requires cardiopulmonary bypass and aortic cross clamping. 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. Arterial switch operation presented during the 3rd african association of cardiovascular and thoracic surgery training at the college of health sciences, university of nairobi. 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.
Are there indications for atrial switch or atrial inversion. 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. In this observational study we aimed to determine the value of a comprehensive cardiovascular magnetic resonance cmr protocol for the detection of coronary. Meijboom, md, and stefano di bernardo, md department of pediatric cardiology and department of cardiovascular surgery, university hospital, lausanne, switzerland. The society of thoracic surgeons sts congenital heart surgery database shows an expected outcome of 1. Arterial switch operation with ventricular septal defect. 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. Intramural coronary arteries and outcome of neonatal arterial switch operation olivier metton, et al european journal of cardiothoracic surgery 37 2010 12461253. Jones, md,a natasha khan, md,a paul clift, md,b william j. The operation is lengthy and requires the surgeon to perform several complex procedures together. Late outcomes after arterial switch operation for taussigbing anomaly.
It is for this reason that the operation is performed in the newborn period. Longterm outcomes after an arterial switch operation for. Adib jatene developed the arterial switch operation in 1975 in sao paulo, brazil. The aorta and the pulmonary artery are transected above the valves, moved to the correct position, and sewn in place. Expanding the boundaries of the primary arterial switch operation. Longterm fate of the aortic valve after an arterial. Longterm fate of the aortic valve after an arterial switch. 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.
Transposition of the great arteries tga is a cyanotic congenital heart defect in. T1 late complications following the arterial switch operation. Theage at operation was arterial switch repair, 72% had the left anterior descending and circumflex. 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. This operation will require the use of cardiopulmonary bypass heartlung machine. Arterial switch operation aso has been optimal for children with transposition of. After these efforts, informationwasstill notobtainedduringthis followupin 26. We sought to determine the midterm results of this intervention. 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. Surgical mortality during this period was analyzed retrospectively.
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. 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. Article information, pdf download for the arterial switch operation in. Role of cardiovascular magnetic resonance imaging in postoperative followup after the arterial switch operation for transposition of the great arteries. The aso is considered the standard procedure for correction of tga, with low mortality and. Longterm outcomes of the arterial switch operation for. 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. Read at the 94th annual meeting of the american association for thoracic surgery, toronto, ontario, canada, april 2630, 2014. The coronary pattern was yacoub type a, in which coronary transfer is usually thought to be easy. 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. Pediatric cardiothoracic surgery arterial switch operation. The difficulty with this operation is the coronary arteries. Current expectations for newborns undergoing the arterial. 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.