• Journal of Chest Surgery
• /
• v.30 no.11
• /
• pp.1121-1124
• /
• 1997

This is a report of a successful, rapid two-stage arterial switch operation in an infant with dextrotransposition of great arteries with an intact ventricular septum beyond the appropriate time for arterial switch operation.'A 4-month-old female infant was admitted due to severe cyanosis, respiratory insufficiency, and frequent dia rhea secondary to ischemic colitis. Echocardiographic examination presented marked leftward deviation of the interventricular septum, and left and right ventricular pressures as measured by cardiac catheterization were 40/4 mmHg and 85/2 mmHg, respectively. Fifteen days after a preparatory operation (pulmonary artery band with modified right Blalock-Taussig shunt), left ventricular-right ventricular systolic pressure ratio increased to 105/90. Arterial switch operation associated with the division of the right Blalock-Taussig shunt and the removal of pulmonary artery band was performed. A(leer the operation, the infant showed normal cardiac function with no postoperative complication.

• Journal of Chest Surgery
• /
• v.27 no.9
• /
• pp.746-751
• /
• 1994

We reviewed our entire experience of 44 consecutive patients undergoing the arterial switch operation [ASO] for transposition of the great arteries [TGA] since March 1985.There were 28 patients with simple TGA[group I] and 16 with associated ventricular septal defect[VSD] [Group II] There were five hospital deaths[11.4%, 5/44], two related to single right coronary artery anatomy. There have been no late deaths. For group I hospital mortality was 14.3%[4/28], and for group II this was 6.25%[1/16]. Mean follow-up was 3.3 years[range 1 month to 8 years] and was completed for all patients. Actuarial survival at 7 years for hospital survivors was 85 $\pm$ 3.2 % in group I and 94 $\pm$ 3.5% in groupII. One patient has mild asymptomatic left ventricular outflow tract obstruction, and five patients [12.8 %,5/ 39] have right ventricular outflow tract gradients[RVOTO] exceeding 25 mmHg; only one patient has required reoperation for RVOTO. Mild neoaortic regurgitation is present in one patient. All survivors are currently in NYHA class I without medicalion, and all are in sinus rhythm. The ASO is associated with low operative risk and excellent medium-term outcome in most subsets of patients undergoing this operation. With more experience, improved results can be expected also in those patients currently at higher risk.

• Journal of Chest Surgery
• /
• v.54 no.2
• /
• pp.146-149
• /
• 2021

Coronary artery bypass grafting (CABG) is rarely performed in infants because of its technical difficulty and unclear long-term results. A 90-day-old male infant weighing 3.5 kg who underwent an arterial switch operation (ASO) for transposition of the great arteries developed left coronary artery insufficiency despite augmentation and reimplantation of the left coronary button. On-pump beating heart CABG was performed using an internal mammary artery graft to revascularize the left anterior descending artery. Postoperative computed tomography angiography revealed that the graft was patent. At 7 months postoperatively, the patient weighed 8.5 kg, and echocardiography revealed good ventricular function. CABG can be an alternative treatment for post-ASO coronary complications in early infancy.

• Korean Journal of Radiology
• /
• v.22 no.11
• /
• pp.1894-1908
• /
• 2021

Double outlet right ventricle (DORV) is a relatively common congenital heart disease in which both great arteries are connected completely or predominantly to the morphologic RV. Unlike other congenital heart diseases, DORV demonstrates various anatomic and hemodynamic subtypes, mimicking ventricular septal defect, tetralogy of Fallot, transposition of the great arteries, and functional single ventricle. Because different surgical strategies are applied to different subtypes of DORV with ventricular septal defects, a detailed assessment of intracardiac anatomy should be performed preoperatively. Due to high spatial and contrast resolutions, cardiac CT can provide an accurate characterization of various intracardiac morphologic features of DORV. In this pictorial essay, major anatomic factors affecting surgical decision-making in DORV with ventricular septal defects were comprehensively reviewed using three-dimensional cardiac CT data. In addition, the surgical procedures available for these patients and major postoperative complications are described.

• Journal of Chest Surgery
• /
• v.24 no.1
• /
• pp.15-25
• /
• 1991

From February 1988 to December 1990, 42 patients underwent so called REV operation for pulmonary stenosis or atresia with or without anomalies of ventriculoarterial connection and truncus arteriosus. The principles of operative technique are mobilization of pulmonary arterial tree beyond the pericardial reflection, transection of pulmonary trunk between the pulmonary ventricle and pulmonary artery, suture of distal pulmonary arterial stump to the upper margin of Pulmonary ventriculotomy site with absorbable suture, and anterior patch with 0.625% glutaraldehyde fixed autologous pericardium with monocusp inside it. Age at operation ranged 3-156months [mean 41.8 month] with twelve of whom infants. Operative indications were pulmonary atresia, with ventricular septal defect[16], and pulmonary stenosis with double outlet right ventricle[8], with ventricular septal defect[16], with double outlet right ventricle[8], with complete transposition of the great arteries[8], with corrected transposition of the great arteries[6], with Fallot`s tetralogy[3], and truncus arteriosus[1]. There were six hospital deaths[14%] and no late death. Twenty-four of 36 survivals were followed up more than 12 months with good clinical results. Postoperative angiocardiogram was performed in fifteen patients. Hemodynamically, two patents had residual pressure gradients along the pulmonary outflow tract, one patient showed severe pulmonary regurgitation; morphologically, there were six significant stenosis of left pulmonary arterial tree, two of whom showed significant pressure gradients. Our present experience with REV operation suggests that this technique make it possible to perform anatomic repair in a wide variety of congenital anomalies of abnormal ventriculoarterial connection associated with pulmonary outflow tract obstruction without using the prosthetic material, even in infants, with relatively low mortality and morbidity.

• Journal of Chest Surgery
• /
• v.18 no.4
• /
• pp.623-634
• /
• 1985

One of the most widely recognized problems in patients with TGA [transposition of the great arteries] after the Senning operation is the occurrence of arrhythmias. From June 1982 through October 1984, 22 patients, 11 with "simple" and 11 with "complex" TGA, underwent correction of TGA by a modification of the Senning operation designed to avoid dysrhythmias. 16 were males and 6 females, with ages ranging from 3 months to 27 months. [mean age 10.8 months] 7 patients [31.8%], 1 with simple TCA and 6 with complex TGA, died in the early post-operative period. The operative mortality was 9.1% in "simple" TGA, and 54.9% in "complex" TGA. There were 4 late deaths but only one of these patients died of a dysrhythmia as a possible factor. The standard ECG [Electrocardiography] checked preoperatively showed sinus rhythm in 17 [77.3%], 1 AV block in 5 [22.7%]. In 22 patients studied postoperative 1st day, the incidence of arrhythmias was 63.6%, with significant incidence compared with preoperative study. [P<0.05]. But, in 15 patients studied postoperatively at intervals from 1 month to 26 months, the incidence of arrhythmias was 26.7%, with no significant incidence compared with preoperative study [P>0.1]. Our results indicate that a modified Senning operation may reduce the frequency of surgically induced arrhythmias. The mean frontal plane P-wave axis also revealed significant deviation to the right side [P<0.05], compared with preoperative study. These findings raise the possibility that what has been called sinus rhythm postoperatively may have a different origin and conduction sequence from normal. But the rhythm seems to be functionally similar.rhythm seems to be functionally similar.

• Clinical and Experimental Pediatrics
• /
• v.52 no.8
• /
• pp.910-916
• /
• 2009

Purpose : The arterial switch operation (ASO) has become the preferred procedure for the surgical management of transposition of the great arteries (TGA). We conducted a retrospective evaluation of our experience in 30 patients seen from January 2003 to July 2008, in order to determine outcomes and related risk factors after the arterial switch operation. Methods : Patients charts, surgical reports, and echocardiograms were retrospectively reviewed. And they were analyzed in 2 different groups: complex (n=16) versus simple TGAs (n=14). Complex TGAs are TGAs with VSD or the Taussig-Bing anomaly with or without aortic arch anomalies. Simple TGAs are defined as TGAs with intact ventricular septum having no such anomalies. Median follow-up time was 44 months (3-63 months). Results : Hospital mortality was 0%. However, follow-up echocardiographies revealed potential complications, including stenosis of the branch pulmonary arteries, neo-aortic and/or neo-pulmonary valvar regurgitation, and right or left ventricular outflow tract obstructions. Great arterial relationship (side-by-side), association of aortic arch anomalies, and the existence of the Taussig- Bing anomaly were assessed as significant risk factors of neo-aortic and/or neo-pulmonary valvar regurgitation in this series. On the other hand, right or left ventricular outflow tract obstructions were more frequently found in patients demonstrating VSD, side-by-side positioned great arteries, or associated coronary anomalies. Conclusion : The ASO is the procedure of choice in the treatment of TGA. However, special attention and follow-ups are needed to detect residual problems like the stenosis of the branch pulmonary arteries, neo-aortic and/or neo-pulmonary valvar regurgitation, as well as ventricular outflow tract obstructions.

• Journal of Chest Surgery
• /
• v.34 no.3
• /
• pp.243-245
• /
• 2001

여호와의 증인을 부모로 둔 환아는 생후 4개월, 5.6kg이었다. 심초음파상 완전 대혈관 전위와 심실 중격 결손, 심방 중격 결손, 동맥관 개존중 및 양측상대 정맥이 관찰되었다. 수술전 혈색소 값은 14.9 g/dl이었다. 수혈없이 심실 중격 결손 교정과 대혈관 치환술을 시행하였으며, 별문제 없이 수술 후 16일에 환아는 퇴원하였다. 퇴원 당시 혈색소 값은 12.8 kg/dl 였다. 복잡 심기형을 가진 영아에서 수술전 eryrhropoietin의 투여, 수술중 철저한 지혈 및 초여과법등의 방법으로 수혈 없이 완전 교정술이 가능하였기에 보고하는 바이다.

• Journal of Chest Surgery
• /
• v.22 no.5
• /
• pp.753-759
• /
• 1989

Recently, the arterial switch operation has received more interest and increased application for many patients with TGA [Transposition of the Great Arteries]. Not all patients, however, are suitable candidates for this approach, and its success will be measured against the Senning procedure. From June 1982 through June 1989, 48 consecutive patients underwent correction of TGA by a modification of the Senning procedure in our hospital. 34 were males and 14 females, with ages ranging from 3 months to 99 months [mean age 14 months]. The patients were divided into two groups, group I [TGA with intact ventricular septum or without significant pulmonary hypertension] and group II [TGA with significant pulmonary hypertension]. The hospital mortality was 9.5 % in group I and 55.6 % in group lI. 31 patients were discharged from the hospital after a Senning operation and have been followed a mean of 31.2 months. There were 5 late deaths, 3 in group I and 2 in group II. All patients were followed up with EKG, echocardiogram, and in several cases, Holter monitor and cardiac catheterization and angiography were also performed. There have been arrhythmias in 7, superior vena caval obstruction in 5, pulmonary venous obstruction in 2 and tricuspid insufficiency and/or right ventricular dysfunction in 16 patients. The Senning operation for Simple TGA can be performed with a low operative mortality and morbidity, but tricuspid insufficiency and/or depressed right ventricular function can be a problem with prolonged follow up.

• Journal of Chest Surgery
• /
• v.44 no.2
• /
• pp.115-122
• /
• 2011

Background: The intramural coronary artery has been known as a risk factor for early death after an arterial switch operation (ASO). We reviewed the morphological characteristics and evaluated the early and mid-term results of ASO for patients with an intramural coronary artery. Materials and Methods: From March 1994 to September 15th 2010, 158 patients underwent ASO at Dong-A and Pusan National University Hospitals for repair of transposition of the great arteries and double outlet right ventricle. Among these patients, 14 patients (8.9%) had an intramural coronary artery. Mean age at operation was $13.4{\pm}10.2$ days (4 to 39 days) and mean body weight was $3.48{\pm}0.33$ kg (2.88 to 3.88 kg). All patients except one were male. Eight patients had TGA/IVS and 4 patients had an aortic arch anomaly. Two patients (14.3%) had side-by-side great artery relation, of whom one had an intramural right coronary artery and the other had an intramural left anterior descending coronary artery. Twelve patients had anterior-posterior relation, all of whom had an intramural left coronary artery (LCA). The aortocoronary flap technique was used in coronary transfer in 8 patients, of whom one patient required a switch to the individual coronary button technique 2 days after operation because of myocardial ischemia. An individual coronary button implantation technique was adopted in 6, of whom 2 patients required left subclavian artery free graft to LCA during the same operation due to LCA injury during coronary button mobilization and LCA torsion. Results: There was 1 operative death (7.1%), which occurred in the first patient in our series. This patient underwent an aortocoronary flap procedure for coronary transfer combining aortic arch repair. Overall operative mortality for 144 patients without an intramural coronary artery was 13.2% (19/144). There was no statistical difference in operative mortality between the patients with and without an intramural coronary artery (p>0.1). There was no late death. The mean follow-up duration was $52.1{\pm}43.0$ months (0.5 to 132 months). One patient who had a subclavian artery free graft required LCA stenting 6.5 years after surgery for LCA anastomotic site stenosis. No other surviving patient needed any intervention for coronary problems. All patients had normal ventricular function at latest echocardiography and were in NYHA class 1. Conclusion: The arterial switch operation in Transposition of Great Arteries or Double Outlet Right Ventricle patients with intramural coronary can be performed with low mortality; however, there is a high incidence of intraoperative or postoperative coronary problems, which can be managed with conversion to the individual coronary button technique and a bypass procedure using a left subclavian free graft. Both aortocoronary flap and individual coronary button implantation techniques for coronary transfer have excellent mid-term results.