The arterial switch operation aso has been the surgical correction of choice for transposition of the great arteries tga for more than 30 years. Arterial switch operation with and without coronary relocation for. Managing the posterior coronary loop in the arterial. Pdf complete transposition of the great arteries tga accountsfor 5% to 7% of congenital cardiac anomalies, and representsthe second. During the procedure, the great arteries are cut off the heart just above the associated valve and then are switched to their usual position. An arterial switch operation is contraindicated because of the presence of ventriculoarterial concordance. Arterial switch operation with ventricular septal defect. Di donato 1 fabrizio gandolfo 0 vincenzo affinito 0 gianluca brancaccio 0 0 department of cardiac surgery, ospedale pediatrico bambino ges, rome, italy 1 department of pediatric cardiac surgery, prince sultan cardiac center, riyadh, saudi arabia posterior coronary looping remains a risk factor when performing an arterial switch operation for transposition of the great arteries. Transposition of the great arteries orphanet journal of.
These include vsd patch closure, aortic arch repair, and arterial switch operation, which is further complicated by complex coronary anatomy and aortopulmonary size mismatch and the need to address subaortic obstruction. Report surgical results of arterial switch operation for taussigbing anomaly your name. Atrial switch procedure is for the rare anomaly of isolated ventricular inversion. 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. The arterial switch procedure requires cardiopulmonary bypass and aortic cross clamping. Midterm results after the arterial switch operation for transposition of the great arteries with intact ventricular septum. The arterial switch operation aso, first described by jatene in 1976, in which the great arteries and the coronary arteries are transected and translocated, is nowadays the standard procedure 3. The neonatal arterial switch operation aso has become the standard of care for transposition of the great arteries, including transposition with intact ventricular. Arterial switch operation for a complex transposition of. Arterial switch operation was performed at a median age of days and mustard operation at 2 years. Pediatric cardiothoracic surgery arterial switch operation. Late complications following the arterial switch operation. The cardiac surgery indicators are included in the society of thoracic surgeons sts congenital heart surgery database and in the national quality forum nqf standards for.
Several anatomical features can hardly be considered complex today, namely, normal coronary anatomy, circumflex coming off the right coronary artery, eccentric ostium, and early takeoff of an. The jatene procedurearterial switch operation or arterial switchis an open heart surgical procedure used to correct dextrotransposition of the great arteries dtga. Coil embolization of an anomalous bronchial artery originating from the left subclavian artery following arterial switch operation. Coronary artery anatomy and transposition of the great. 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. The association with an aortic arch obstruction aao, seen predominantly in taussigbing increased significantly the complexity of the operation. Guideline dtga arterial switch operation orphanet journal of rare diseases 2008,3. Colan sd, sanders sp, parness ia, keane jf, mayer je, jonas ra, et al. Following aortic cross clamping, the ascending aorta and main pulmonary artery are transected. Surgery for congenital heart defects wiley online books. This operation, called an arterial switch operation, is done within the first few weeks of life.
Arterial switch operation with a single coronary artery. Arterial switch operation olivier metton, et al european journal of cardiothoracic surgery 37 2010 12461253. A 28dayold infant with dtransposition of the great arteries underwent arterial switch operation. Thirty infants underwent arterial switch for transposition of the great arteries within the first week of life mean age, 2. This procedure, a form of atrial switch, was developed and first.
A case report series 203 from a single institution case 1. Arterial switch operation or arterial switch, is an open heart surgical procedure used to correct dextrotransposition of the great arteries dtga. Surgery often is performed in the first weeks of life, and the most common approach is the arterial switch procedure. The outcome in childhood is encouraging but only limited data for longterm outcome into adulthood exist. Surgical results of arterial switch operation for taussig. The coronary pattern was yacoub type a, in which coronary transfer is usually thought to be easy. Mar 30, 2016 arterial switch operations undertaken in transposition of the great arteries tga and taussig bing with ventricular septal defect vsd are complex. Arterial switch operation aso has been optimal for children with transposition of great arteries tga in either simple or complex form with an excellent survival rate. The left and right coronary artery ostia are visualized and excised from the aortic root with adjacent aortic wall as buttons. During the surgery, arteries are put back in their correct place. Arterial switch to 12 oclock associated with reduced. Babies born with transposition of the great arteries undergo the. This operation results in suture lines across the ascending aorta and pulmonary trunk, as well as around the coronary ostia 4.
Earlier arterial switch operation improves outcomes and reduces costs for neonates with transposition of the great arteries. The following data show childrens hospital of philadelphia s chop outcomes for the arterial switch operation, for the repair of transposition of the great arteries. Chronological changes in stenosis of translocated coronary arteries on angiography after the arterial switch operation in children with transposition of the great arteries. The arterial switch operation aso has become the preferred method for surgical correction of transposition of the great arteries tga and taussigbing anomaly.
The standard treatment of transposition of the great arteries is the arterial switch operation aso. Oct, 2008 transposition of the great arteries tga, also referred to as complete transposition, is a congenital cardiac malformation characterised by atrioventricular concordance and ventriculoarterial va discordance. This article is from international cardiovascular research journal, volume 8. Early and midterm followup of patients receiving arterial.
Evaluation of electrocardiographic changes after arterial. Arterial switch operation for a complex transposition of the. A case of arterial switch operation with coronary elongation. It was the first method of dtga repair to be attempted, but the last. The arterial switch operation has been the accepted pro cedure for the repair of transposition of the great.
An arterial switch procedure is an open heart surgery that restores a normal blood circulation in your babys body. Noninvasive assessment of autonomic cardiovascular. This is a pdf file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of. The arterial switch operation in transposition of great arteries or double outlet right ventricle patients with intramural coronary can be performed with low mortality. Abstractbackground transposition of great arteries tga is a serious congenital. Switch operation is good myocardial function at rest is normal stress testing may unmask regional wall abnormalities rvoto common complication reintervention rate 35% neoaortic root dilatation in 1st y of life normalizes within 10 y sign.
The arterial switch operation aso is currently the treatment of choice in neonates with transposition of the great arteries tga. 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. Get a printable copy pdf file of the complete article 1. The incidence is estimated at 1 in 3,5005,000 live births, with a maletofemale ratio 1. The arterial switch procedure operative techniques in thoracic. Pdf cannot extubate a newborn patient after an arterial. The modern repair that is preferred is called the arterial switch operation aso for short. 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. Guideline dtga arterial switch operation wernovsky g, rome jj, tabbutt s, et al. Pregnancy outcomes in women with transposition of the. The arterial switch operation has become a safe operation in many centres. The society of thoracic surgeons sts congenital heart surgery database shows an expected outcome of 1.
Angeli e, formigari r, pace napoleone c, oppido g, ragni l, picchio fm, et al. Pregnancy outcomes in women with transposition of the great. 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. Noninvasive assessment of autonomic cardiovascular function. The arterial switch operation aso has replaced atrial switch procedures for d tga, and 90% of patients now reach adulthood. Pdf arterial switch operation for transposition of great arteries. Arterial switch procedure radiology reference article. In 1975, jatene and associates described the first successful arterial switch procedure in a patient with dtransposition of the great arteries and a large ventricu. Permanent treatment requires a surgical procedure to switch the arteries to their proper places. Prevention of left ventricular involution until the patient is stable for an arterial switch operation is a real challenge. Arterial switch operation presented during the 3rd african association of cardiovascular and thoracic surgery training at the college of. Transthoracic echocardiograms were obtained before hospital discharge.
The senning procedure is an atrial switch heart operation performed to treat transposition of the great arteries. Jan 01, 2005 the case we report on describes a neonatal arterial switch operation in a patient with dextrocardia, complete transposition of the great arteries s,d,d, ventricular septal defect, aortic arch hypoplasia, superoinferior ventricles and juxtaposition of the morphologically right atrial appendage. N2 the arterial switch operation has been the principal treatment for transposition of the great arteries and its variants for the last 25 years. We report a case of early ductal stenting to keep the left ventricle well trained in a separated conjoined twin who eventually underwent an arterial switch operation. Moreover, the lca ostium itself was near the remote commissure in sinus 1, very far from the. Arterial switch operation for transposition of the great arteries with. Longterm coronary artery outcome after arterial switch operation for transposition of the great arteries. Any abnormal holes between the ventricles or atria also are closed. We present an 18yearold man with a history of transposition of the great arteries for which an arterial switch operation and a transpulmonary closure of an associated ventricular septal defect were performed shortly after birth. After these efforts, informationwasstill notobtainedduringthis followupin 26 patients not known to be dead. Effect of prostaglandin duration on outcomes in transposition of the great arteries with intact. Percutaneous closure of an uncommon aortic pseudoaneurysm. Segmental wallmotion abnormalities after an arterial. The arterial switch operation for transposition of the great.
Complexity stratification of the arterial switch operation. Expanding the boundaries of the primary arterial switch operation. The operation is lengthy and requires the surgeon to perform several complex procedures together. In 50% of cases, the va discordance is an isolated. There was marked cardiomegaly with an ascending aorta diameter of 10 mm, the thickness of the left ventricular posterior wall at end. During the operation, the arteries are repositioned. Guidelines for the outpatient management of complex congenital heart disease.
It was the first method of dtga repair to be attempted. Clinical outcomes after the arterial switch operation for. Coronary artery obstruction after the arterial switch operation for transposition of the great arteries in newborns. It is named after its inventor, the swedish cardiac surgeon ake senning 19152000, also known for implanting the first permanent cardiac pacemaker in 1958. Mortality is higher when there are additional defects like a hole in the heart vsd or narrowing of the arteries to the body aorta. This study was aimed to analysis the early and midterm results of patients receiving aso for tga and taussigbing anomaly in our institute.
Neonatal arterial switch operation for transposition of the great arteries in a patient with mirror image dextrocardia and situs inversus totalis. Outcome in adult patients after arterial switch operation for. It is an openheart procedure that requires a temporary stopping of the babys heart while a heartlung machine handles respiration and blood circulation. T1 late complications following the arterial switch operation. When the aorta and pulmonary artery are transposed, an aterial switch is required.
Arterial switch operation and complex coronary patterns. In 50% of cases, the va discordance is an isolated finding. Kirklin et al riskfactors in arterial switch operation for transposition 1503 was received within 3 weeks, strenuous attempts were madetolocateandinterrogate,bytelephone,thefamily orotherresponsible persons. It is generally preferred over atrial switch procedures for simple dtga due to improved outcomes 4. The complexity of the procedure has evolved over the last two decades. Transposition of the great arteries tga, also referred to as complete transposition, is a congenital cardiac malformation characterised by atrioventricular concordance and ventriculoarterial va discordance.
Median followup was 22 years range 2025 and 25 years 2229, respectively. Postoperative complications and their management after. Neonatal arterial switch operation for transposition of the great. Between 2005 and 2009, the operative mortality of 1,671 asos in the society of thoracic surgeons congenital database. Followup of patients who underwent arterial switch repair.
Arterial switch to the 12 oclock position is associated with abnormal coronary perfusion in adolescence, reveals new research. Coronary artery anatomy and transposition of the great arter. 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. The arterial switch operation aso has evolved from a pioneering neonatal procedure to a reproducible technique allowing anatomic repair of transposition of the great arteries tga and selected forms of doubleoutlet right ventricle dorv. The case we report on describes a neonatal arterial switch operation in a patient with dextrocardia, complete transposition of the great arteries s,d,d, ventricular septal defect, aortic arch hypoplasia, superoinferior ventricles and juxtaposition of the morphologically right atrial appendage. The arterial switch operation is appropriate treatment for most forms of transposition of the great arteries. This operation results in suture lines across the ascending aorta and pul. Transposition of the great arteries the patient guide to. At bypass termination, immediately after protamine. Immediate postoperative holter and 15lead electrocardiograms ecg were evaluated for ischemia. It has been shown in animal models that the autonomous innervation of the heart is damaged in the immediate postoperative period following an arterial switch operation 5.
Surgical treatment of complete transposition of the great. The arterial switch operation aso for the transposition of the great arteries tga with intra mural coronary arteries has been performed using. Longterm fate of the aortic valve after an arterial. Pdf arterial switch operation with a single coronary. However, a dominant conus branch diverged from the proximal portion of the left coronary artery lca. This operation was introduced late in china, but there has been a decreasing mortality in recent years. Theage at operation was arterial switch repair, 72% had the left anterior descending and circumflex. Despite successful surgical correction, patients cannot tolerate extubation after the.
Request pdf pregnancy outcomes in women with transposition of the great arteries and arterial switch operation there is a growing population of young women of childbearing age with complete. Chronological changes in stenosis of translocated coronary. The aso is considered the standard procedure for correction of tga, with low mortality and. Managing the posterior coronary loop in the arterial switch.
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