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@#Objective To compare the early and mid-term results between Fontan operation and anatomic correction for congenitally corrected transposition of the great arteries (ccTGA). Methods The clinical data of 53 patients with ccTGA who underwent anatomic correction and Fontan operation from January 2009 to September 2021 in our hospital were reviewed, including 41 males and 12 females with a mean age of 55.02 (3-168) months. They were divided into an anatomic correction group (16 patients) and a Fontan operation group (37 patients) according to the operation. The hospitalization mortality, survival rate, postoperative complications, and free rate from re-intervention between the two groups were compared. Another 180 healthy children were recruited as a control group, and 14 children were matched with the propensity score matching method as a Fontan control group. The results of cardiopulmonary exercise testing (CPET) between the Fontan operation group and the Fontan control group were compared. Results There were 2 (12.5%) early deaths and 3 (18.8%) early re-intervention in the anatomic correction group, while 1 death and 2 re-intervention in the Fontan operation group. In addition, there were 9 patients (56.3%) in the anatomic correction group and 6 (16.2%) patients in the Fontan operation group suffering from arrhythmia after operation, respectively. Compared with the anatomic correction group, cardiopulmonary bypass time, aortic cross-clamping time, intubation time and ICU stay were significantly shortened in the Fontan operation group (P<0.05). CPET results showed that, percent predicted max VO2 in the Fontan operation group was lower than that in the Fontan control group (0.84±0.11 vs. 0.99±0.12, P<0.05). The patients were followed up for 0.5-126.0 months. Two patients were lost in the Fontan operation group. There was no death and 1 re-intervention in the anatomic correction group, while no death or re-intervention in the Fontan operation group. The 1-year, 5-year and 10-year transplant-free survival rate of the anatomic correction group and the Fontan operation group was 87.5%, 87.5%, 87.5% and 97.3%, 97.3%, 97.3%, respectively (P>0.05). The 48 patients were classified as grade Ⅰ-Ⅱ in cardiac function in the last follow-up. Conclusion There is no statistical difference in the transplant-free survival rate between the anatomic correction and the Fontan operation group. The postoperative complications in the Fontan operation group are decreased than those in the anatomic correction group. The Fontan operation is also a good choice, even though the patients with ccTGA meet the condition of the procedure of anatomic correction.
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ABSTRACT Introduction: Congenitally corrected transposition of the great arteries (CCTGA) is a rare anomaly. Current data available regarding adult cases is derived from small series, information simultaneously presented in pediatric publications, and one classical multicenter study. This review, not aimed to exhaust the subject, has the purpose to examine the literature addressing presentation, diagnostic methodology, and management of afflicted adult patients. Methods: A comprehensive search was undertaken in three major databases (PubMed, Cochrane, SciELO), using the keywords "congenitally corrected transposition of the great arteries" and "adults". Relevant articles in English, Spanish, and Portuguese were extracted and critically appraised in this review. Steps for study selection were: (1) identification of titles of records through databases searching, (2) removal of duplicates, (3) screening and selection of abstracts, (4) final inclusion in the study. Results: Four hundred sixty-five publications on CCTGA in adult patients were retrieved, and 166 were excluded; 299 studies were used for this review including 76 full-text articles, 70 studies related to general aspects of the subject, and, due to the small number of publications, 153 case reports. Sixty-one articles referring to combined experiences in pediatric and adult patients and judged to be relevant, but retrieved from another sources, were also included. Conclusion: Albeit clinical presentation and diagnostic criteria have been well stablished, there seems to be room for discussion related to clinical and surgical management of CCTGA in adults. Considering the rarity of the disease, well designed multicenter studies may provide answers.
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@#Objective To explore the operative strategy after palliative shunt for correcting congenitally corrected transposition of great artery (cTGA) patients with left ventricular outflow tract obstruction (LVOTO) and cardiac malpostion. Methods We retrospectively analyzed the clinical data of 54 patients with onsecutive cTGA with LVOTO and cardiac malpositon from June 2011 to May 2019. The patients were devided into two groups. There were 24 patients (16 males and 8 females at mean age of 5.4±2.2 years) who underwent one and a half ventricle repair as a one and half ventricle group. And there were 30 patients (19 males and 11 females at age of 8.6±6.2 years) who underwent one ventricle repair operation as a one ventricle group. Follow-up data were collected by telephone interviews. Results There was no statistical difference in systemic atrioventricular valve regurgitation and systemic ventricular ejection fraction between the two groups (P>0.05). Compared with one and a half ventricle group, the cardiopulmonary bypass time (CPB) time, mechanical ventilation time and intensive care unit stay were significant shorter than those in the one ventricle group (P<0.05), but prolonged pleural effusions developed more frequently in the one ventricle repair group (P<0.05). There was no in-hospital death but 1 follow-up death in each group. The follow-up time was 49 (17-38) months in the one and half ventricle group at follow-up rate of 93.9%, and 47 (12-85) months at follow-up rate at 90.9% in the one ventricle group. One and a half ventricle group had better systemic ventricular ejection fraction (EF) than that in the one ventricle repair group. And the rate of heart function (NYHA) class Ⅲ and class Ⅳ in one and a half ventricle group was lower than that in the ventricle group. No significant difference of survival and freedom from re-intervention probability between the two groups was found. Conclusion For patients of correction of cTGA with LVOTO and cardiac malposition after palliative shunt, the one-and-a-half ventricular repair procedure is ideal operative strategy.
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@#Congenitally corrected transposition of the great arteries (ccTGA) or ventricular inversion, is a rare form of congenital heart disease (CHO) representing approximately 0.5% of all CHO. It is characterized by atrioventricular and ventriculoarterial discordance, in which the atria are connected to the opposite ventricle, and the ventricles are connected to the incorrect great artery. The defect is termed "corrected" because of the physiologic flow of blood through the body despite the malformation. ccTGA can be associated with other cardiac anomalies like ventricular septa! defect (VSO), pulmonary outflow tract (LVOT) obstruction, tricuspid valve lesions, and coronary artery anomalies. This paper aims to discuss the anesthetic management unique to patients with ccTGA in which the ultimate goal is to prevent hemodynamic instability that could potentially lead to cardiac failure. Here, we report the anesthetic management of a 6 year old child with ccTGA with mild tricuspid regurgitation who underwent plastic repair of cleft lip under general endotracheal tube anesthesia (inhalational). With use of balanced anesthesia to produce minimal to no cardiovascular effects, the operation concluded successfully.
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@#Objective To evaluate the effects of anatomic correction for congenitally corrected transposition of the great arteries (ccTGA) and 10-year follow-up. Methods From January 2008 to December 2018, 48 patients with ccTGA who underwent anatomic correction were reviewed. There were 29 males and 19 females with age of 39.2 (3-91) months. The cohort was divided into two groups: a biventricular anatomic correction group (39 patients) and a 1.5 ventricular anatomic correction group (9 patients). They were followed for in-hospital mortality, late mortality, long-term survival, freedom from reoperation, and heart function. Results There were 3 early deaths and 2 early re-intervention in the biventricular anatomic correction group, but no death and only one re-intervention in the 1.5 ventricular anatomic correction group. Compared with the biventricular anatomic correction group, the operation time, tracheal intubation and ICU time were significantly reduced or shortened in the 1.5 ventricular anatomic correction group (P<0.05). The patients were followed up for 0.5-10.4 years. Four patients were lost. Two patients died in the biventricular anatomic correction group, and two patients received re-intervention. The 1-year, 5-year and 10-year survival rate was 88.2%, 84.0%, and 84.0%, respectively. There was no death or intervention in the 1.5 ventricular anatomic correction group. The quality of life of the other patients in the medium-term follow-up was satisfactory. Only 2 patients were classified as grade Ⅲ in cardiac function, and the other patients were classified as grade Ⅰ-Ⅱ. Conclusion According to the different anatomic characteristics of ccTGA, the individualized strategy of anatomic correction can achieve satisfactory surgical results, and the medium-term quality of life was good. Especially, 1.5 ventricular anatomic correction may obtain better therapeutic effects because of its lower operative mortality and less postoperative complications.
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Objective To review the early-and mid-term results of anatomic repair or Fontan pathway for congenitally corrected transposition of the great arteries(ccTGA) in a single institution of China.Methods Hospital records over a 9-year period(2009-2017) were reviewed to identify patients with ccTGA who underwent anatomic repair or Fontan pathway.Pa-tient-and procedure-related variables were reviewed.Results We identified 37 patients.Group 1 consisted of 10 anatomic re-pairs, of which 4 required prior pulmonary artery banding.Median age at anatomic repair was 1.0 years( range: 0.3 -7.8 years).There was one early death, and one patients experienced ECMO support.The mean follow-up was(3.0 ±2.8)years (range:0.7-8.4 years).Five(55.5％) patients showed arrhythmias, and one required permanent pacemaker implantation during follow-up.Group 2(27 patients) underwent Fontan palliation, of which 23(85.2％) underwent prior bidirectional Glenn shunt.Median age at Fontan completion was 3.8years(range:2.2-14.3 years).there was one early death with a mor-tality of 3.7％.The mean follow-up was(2.8 ±1.6) years(range:0.8-8.2 years).There was 4(15.4％) cases of arrhyth-mias, but none required reintervention.The arrhythmias incidence in Fontan group was significantly lower than the anatomic re-pair group.The early-and mid-term survival rate were 90.0％ and 96.3％in the two groups.The difference was not statistical-ly significant(P=0.458).Conclusion Patients with ccTGA do well with both anatomic repair and the Fontan pathway in the medium term.Pulmonary artery banding can be used effectively for morphological left ventricular retraining , and extenuate tri-cuspid regurgitation.Excellent outcomes with reduced early complication and arrhythmias incidence can be achieved for this co-hort of patients when a strategy of avoiding complex anatomic repair in favor of the Fontan pathway is used .
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@#Objective To evaluate the long-term clinical effect and risk factors of tricuspid valve replacement (TVR) as a relief treatment for adult patients with congenitally corrected transposition of the great artery (CCTGA). Method We retrospectively analyzed the clinical data of 47 adult patients with CCTGA who underwent tricuspid valve replacement in Fuwai Hospital between 2000 and 2017 year. There were 27 males and 20 females with operation age of 14–62 (38.8±13.5) years. Preoperative echocardiography showed moderate or more tricuspid regurgitation in all patients. The basic data of patients before and during operation were recorded. Survival was followed up by telephone and ultrasound report. Results The average follow-up time was 6.5±3.7 years. The 1-year, 5-year and 10-year survival rate or the incidence of heart transplant-free was 94.6%, 90.5% and 61.7%, respectively. During the follow-up period, the long-term right ventricular ejection fraction of most patients (>90%) was still greater than or equal to 40%. Increased preoperative right ventricular end diastolic diameter (RVEDD) was a risk factor for death or heart transplantation (risk ratio 1∶11, P=0.04). The survival rate of patients with RVEDD (>60 mm) before operation was significantly reduced (P=0.032). Conclusion TVP is a feasible treatment for adult patients with CCTGA. The increase of preoperative RVEDD is a risk factor for long-term mortality.
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Objective To avoid complications associated with the complete Senning procedures and to assist right-heart hemodynamics, this study was undertaken to assess the risks and benefits of the double-switch operation using a hemi-Mustard atrial switch procedure and the bidirectional Glenn operation for congenitally corrected transposition of the great arteries. we fa-vor a modified atrial switch procedure. Methods Between January 2014 and March 2016, anatomic repair was achieved in 26 patients. A hemi-Mustard procedure was the atrial switch procedure for 26. 9％(7/26). The Rastelli-atrial switch procedure was performed in 5 patients( RAS) and the arterial-atrial switch procedure was performed in 2 patients( AAS) . Results There was no in-hospital death after anatomic repair. There were no late deaths in a median follow-up of 7-21 months. Glenn opera-tion complications were uncommon limited to the perioperative period, atrial baffle-related reoperations or sinus node dysfunc-tion had not been observed. Tricuspid regurgitation decreased to mild for 1 case and mild to moderate for 6 cases. Right ventri-cle-pulmonary artery conduit longevity was significantly improved. Conclusion We recentely describe an experience with the double-switch operation using a modified atrial switch procedure with favorable earlyterm results. The risks of the hemi-mustard and bidirectional Glenn operation are minimal and are limited to a well-defined patient subset. The benefits include reduced baffle-and sinus node-related complications, technical simplicity and inspiring results.
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Objective To review and compare various types of operations for congenitally corrected transposition of the great arteries (ccTGA),to provide more suitable surgical procedure and improve surgical results.Methods Analysing 203 patients with ccTGA between June 1999 and June 2014,there were thirten patients who had undergone palliative procedure.Thirty-nine patients had received conventional repair operation.Eighty-eight patients had received double switch operation in which there were three patients of Double Switch With Hemi-Mustard and Bidirectional Glenn Procedure.Sixty-three patients had received other surgical treatments including functional univentricular repair operation.Results There were 13 hospital deaths in all patients,consisted of 2 by conventional repair operation,9 by double switch operation and 2 by other procedure.Conclusion The operative procedure depend on the anatomy and physiology in ccTGA.The double switch operation have relatively higher mortality,more complication,the indication of Double Switch With Hemi-Mustard and Bidirectional Glenn Procedure should be more acceptable,but the long-term outcomes will be followed-up.
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Aims: To recognize heart block as a complication associated with congenitally-corrected transposition of the great arteries (CCTGA). Presentation of the Case: A healthy 36 year old male with CCTGA presented with syncope as a manifestation of heart block. A unique feature of this case was the presence of an accessory pathway that served as the atrio-ventricular conducting structure for more than 3 decades. Discussion: rationale for a cardiac resynchronization device (CRT) as opposed to a simple pacemaker system is emphasized in this case. Conclusion: clinicians must be aware of heart block a frequent complication of CCGTA. CRT appears as a more favorable option than a single systemic ventricular pacemaker in such patients.
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Female , Humans , Young Adult , Aorta, Thoracic/physiopathology , Collateral Circulation/physiology , Pulmonary Artery/physiopathology , Pulmonary Atresia/physiopathology , Transposition of Great Vessels/physiopathology , Aorta, Thoracic , Catheterization, Swan-Ganz , Diagnosis, Differential , Electrocardiography , Pulmonary Artery , Pulmonary Atresia/diagnosis , Transposition of Great Vessels/diagnosisABSTRACT
A 62-year-old woman was admitted to our hospital because of dextrocardia on her chest X-ray film. She had been in good health though the X-ray abnormality had been pointed out from her childhood. Echocardiogram, magnetic resonance imaging, and cardiac catheterization revealed situs inversus, congenitally corrected transposition of the great arteries, and severe tricuspid valve (systemic atrioventricular valve) regurgitation with mild systemic ventricular dysfunction. The surgeon stood on the patient's left side during the operation. On cardiopulmonary bypass, the tricuspid valve, facing almost dorsally, was exposed through a superior transseptal approach. Tricuspid valve replacement with a mechanical valve was performed with leaflet preservation. Systemic ventricular function is preserved at one year after operation.
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La complejidad anatómica y la variabilidad en el sistema de conducción en la transposición congénita corregida de los grandes vasos plantean intervenciones con el uso de recursos tecnológicos que faciliten un desenlace favorable. Describimos un caso de ablación de taquicardia por reentrada intranodal en donde el mapeo no fluoroscópico facilitó una intervención compleja.
The anatomy in congenital corrected transposition of the great arteries is complex and the conduction system may experience large degrees of variation. Invasive procedures should be done with the use of the highest possible technological sources to warrant success. We describe here, a patient with recurrent atrioventricular node reentry tachycardia where non-fluoroscopic navigation system helped in a complex ablation.
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Female , Humans , Middle Aged , Cardiac Imaging Techniques , Catheter Ablation , Imaging, Three-Dimensional , Tachycardia, Atrioventricular Nodal Reentry/surgery , Fluoroscopy , Recurrence , Transposition of Great Vessels/surgeryABSTRACT
Objective To evaluated the early and mid-term results of arterial switch operation (ASO) for patients with intramural coronary artery.Methods From September 2008 to March 2012,75 patients underwent ASO at Guangzhou Women and Children Medical Center for repair of transposition of the great arteries and Taussig-Bing anomaly.Among these patients,7patients (9.3％) had an intramural coronary artery.Mean age at operation was 2.4 months (2 days to 1 year) and mean body weight was(4.3 ±2.2) kg.The TGA and VSD in 3 cases,TGA/IVS in 2,and Taussig-Bing anomaly in 2.Among them 3 patients had an aortic arch anomaly,interruption of the aortic arch in 1 and coarctation of the aorta in 1.The individual coronary button technique was used in coronary transfer in 7 patients,of whom one patient required to unroof the intramural segment,an-other one required to unroof the intramural segment and enlarge with autologous pericardium the because of myocardial ischemia.There was 1 operative death because of low cardiac output syndrome.This patient underwent a coronary transfer combining aortic arch repair but without unroofing the stenotic intramural segment.The mortality was 14.2％.In the same period the mortality for 68 patients without an intramural coronary artery was 4.4％ (3/68).There was no statistical difference in mortalitv between the patients with and without an intramural coronary artery (P ＞ 0.05).Results 6 patients follow-up 4 to 47months.There was no late death.No intramural coronary artery obstruction was identified by cardiac computerize temography.All patients had normal ventricular function and were in NYHA class Ⅰ during follow-up.The intramural coronary artery is well known as a risk factor of ASO.Conclusion The technique of coronary transfer should be individually adapted to each anatomical situation.Individual technique for coronary transfer has excellent results.
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Se presenta una paciente de sexo femenino, de 9 años de edad, que acude a su médico de familia y se le auscultó un soplo al examen físico y sintomatología que se comportaba como una comunicación interventricular. Luego de los estudios correspondientes, se permitió hacer el diagnóstico de transposición corregida de grandes vasos. La paciente tenía asociada una anomalía de Ebstein, comunicación interauricular, una comunicación interventricular, y una persistencia del conducto arterioso, todo lo cual agravaba su cuadro clínico. Primero es intervenida quirúrgicamente, y se cierra el ducto; de manera espontánea, cierra la comunicación interauricular, y la anomalía de Ebstein parchea la comunicación interventricular. La niña desarrolla una insuficiencia cardiaca e hipertensión pulmonar, a consecuencia de las anomalías asociadas. El caso es de interés, ya que son pocos los publicados en la literatura internacional con esta cardiopatía congénita asociada a otras anomalías estructurales del corazón, que modifican su historia natural.
This paper presented a 9 years-old female patient, who went to the family's doctor and was physically examined to detect heart murmur and symptoms of ventricular septal defect. After the corresponding studies, the diagnosis was the corrected transposition of the great arteries. The patient also suffered Ebstein anomaly, atrial septal defect, ventricular septal defect and persistence of arteriose duct, all of which worsened her clinical picture. First, she was operated on and the duct was closed. Later the atrial septal defect closed spontaneously, and the Ebstein anomaly patched the ventricular septal defect. The girl developed heart failure and pulmonary hypertension, as a result of associated anomalies. The case is interesting since few cases like this one, associated with other structural heart anomalies that change its natural course, are presented in the international literature.
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Este é um relato de caso com discussão dos desfechos materno-fetais de gestantes com transposição de grandes vasos congenitamente corrigida (TGVCC). Gestante com transposição de grandes artérias congenitamente corrigida TGACC, internada com 35 semanas de gestação por dispneia e cianose central, evoluindo para parto vaginal com fórcipe e recebendo alta com recém-nascido clinicamente estável. A mesma paciente é internada novamente após 1 ano, gestante e com as mesmas queixas, apresentando dor precordial no trabalho de parto. Foi indicada cesárea por desproporção cefalopélvica. Teve alta clinicamente estável. Os recém-nascidos não apresentaram malformações cardíacas. Em conclusão, gestantes portadoras de TGACC devem receber atenção multidisciplinar diferenciada devido à gestação de alto risco, tendo indicação de parto normal assistido e monitorado, visando diminuir a morbimortalidade materna.
Case report and discussion of maternal-fetal outcomes in pregnant patients with congenitally corrected transposition of the great vessels (CCTGV). A pregnant woman with CCTGV was hospitalized at 35 weeks of gestation for dyspnea and central cyanosis. Her baby was born via forceps delivery and was clinically stable when discharged from hospital. The patient returned to the hospital 1 year later. She was pregnant and presented the same complaints, with precordial pain during labor. Cesarean delivery was indicated due to dystocia. She was clinically stable when discharged from hospital. Both newborns did not have cardiac malformations. Pregnant patients suffering from CCTGV should receive multidisciplinary attention due to the high-risk pregnancy, with recommendation of assisted and monitored vaginal labor to reduce maternal morbidity and mortality.
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Humans , Pregnancy , Adult , Prenatal Care , Parturition , Transposition of Great Vessels/complications , Transposition of Great Vessels/diagnosis , Transposition of Great Vessels/genetics , Transposition of Great Vessels/pathology , Cyanosis/complications , Cyanosis/diagnosis , Dyspnea/complications , Dyspnea/diagnosis , Heart Diseases , Pregnancy, High-RiskABSTRACT
Antecedentes: La transposición corregida de grandes arterias (TCGA) es una cardiopatía congénita rara, asociada a disfunción ventricular derecha. El objetivo del presente trabajo fue evaluar por técnicas de medicina nuclear como la ventriculografía en equilibrio y SPECT sincronizado utilizando Tc-99m sestamibi reposo-esfuerzo, la función y perfusión del ventrículo derecho en pacientes adultos con TCGA no operados y comparar los resultados con el ecocardiograma convencional (ETT) y de contraste (EC). Material y métodos: Se estudiaron 13 pacientes a quienes se les realizó ventriculografía con radioisótopos para evaluar la función ventricular derecha y SPECT sincronizado para estudiar la perfusión y función del ventrículo derecho. Los resultados obtenidos se compararon con el ETT y EC. Resultados: La fracción de expulsión ventricular derecha calculada por ventriculografía tuvo correlación de 0.67 (p = 0.059) con la fracción de acortamiento de áreas y de 0.84 (p = 0.01) para el método de descenso del anillo tricuspídeo. Conclusiones: El EC y SPECT sincronizado son métodos de gran utilidad en el estudio de la perfusión miocárdica del ventrículo derecho en pacientes en el que dicho ventrículo se comporta como sistémico. El índice de concordancia diagnóstica entre estas dos técnicas obtenido fue de 0.76 (p = 0.005) para identificar defectos fijos y 0.68 (p = 0.009) para defectos reversibles.
BACKGROUND: Great arteries corrected transposition is a rare congenital heart disease associated with right ventricle dysfunction. The objective of this study was to assess by equilibrium ventriculography (EV) and gated SPECT with Tc-99m sestamibi rest-stress protocol, right ventricle function and perfusion in adult patients with CTGA without previous surgery, and to compare the results with the standard transthoracic cross-sectional (TTE) and color coded Doppler echocardiography (CE) techniques. METHODS: We studied 13 patients, who underwent ventriculography to assess right ventricle function and gated SPECT to evaluate myocardial perfusion and right ventricle function. The data obtained were compared with TTE and CE. RESULTS: Right ventricle ejection fraction was measured using nuclear medicine and showed a Pearson correlation coefficient of 0.67 (p = 0.059) with the shortening area fraction and 0.84 (p = 0.01) with the tricuspid ring descendent method. CONCLUSIONS: Gated SPECT and Echo contrast are extremely valuable methods in the assessment of myocardial perfusion of the right ventricle in this group of patients. The diagnostic agreement index of both studies was 0.76 (p = 0.005) to identify non-reversible defects and 0.68 (p = 0.009) for reversible defects.
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Humans , Male , Female , Adolescent , Adult , Middle Aged , Coronary Circulation , Echocardiography, Doppler, Color , Echocardiography, Transesophageal , Gated Blood-Pool Imaging , Tomography, Emission-Computed, Single-Photon , Transposition of Great Vessels/physiopathology , Ventricular Function, Right , Transposition of Great Vessels/surgeryABSTRACT
PURPOSE: The prognosis of patients with corrected transposition of the great arteries(C-TGA) is variably affected by associated intracardiac defects, systemic right ventricular function, tricuspid valve competence, and conduction disturbances. This study aims to evaluate the importance of those factors at mid-term follow-up. METHODS: Medical records of 94 patients(males 58, females 36; mean age at last follow-up, 12+/-9 years; mean follow-up duration, 9+/-6.4 years) diagnosed between January 1980 and May 2002 at Seoul National University Children's Hospital were studied retrospectively. RESULTS: Among 94 patients, operations were performed in 72 patients(classic operations in 55; double switch operations in 17). Among prognostic factors including associated intracardiac anomalies(at least moderately severe tricuspid insufficiency(TI), ventricular septal defect, pulmonary stenosis and pulmonary atresia), intracardiac operation and complete atrioventricular block, TI was the only significant factor for death(P=0.001), and in turn, Ebstein anomaly and high grade atrioventricular block predicted TI. 20-year survival without TI was 77%, but only 35% with TI(P=0.0002); excluding perioperative death, the 20-year survival rates with and without TI were 48% and 87% respectively(P= 0.008). There was no statistical difference in 20-year survival rate or association with TI between classic and double switch operation. CONCLUSION: TI was the major prognostic factor for C-TGA and was associated with Ebstein anomaly and high grade atrioventricular block at mid-term follow-up. Long-term follow-up is required to evaluate other factors, including double switch operations and associated intracardiac defects more exactly.
Subject(s)
Female , Humans , Arteries , Atrioventricular Block , Ebstein Anomaly , Follow-Up Studies , Heart Septal Defects, Ventricular , Medical Records , Mental Competency , Prognosis , Pulmonary Valve Stenosis , Retrospective Studies , Seoul , Survival Rate , Tricuspid Valve , Tricuspid Valve Insufficiency , Ventricular Function, RightABSTRACT
PURPOSE: To assess the clinical characteristics and surgical approaches in different anatomical and hemodynamic types of corrected transposition of great arteries(TGA) and learn the surgical results of those patients. METHODS: All 52 patients who were diagnosed as corrected TGA between December 1987 and November 1999 and their medical records were reviewed. Three groups were identified according to associated anomalies', Group 1: TGA with intact ventricular septum(n=7), Group 2: TGA with ventricular septal defect(n=6), Group 3: TGA with ventricular septal defect and pulmonary stenosis(n=39). RESULTS: The clinical manifestations and managements according to associated anomalies were different. The average ages at operation were 190, 8.8 and 47 months in Groups 1, 2, and 3, respectively. The five patients underwent double switch operation and the remainder were managed conventionally without correcting discordant connection. Four patients died and 5 patients were re-operated. Eleven patients developed complete heart block, and 7 of them had permanent pacemakers. Progressive systemic tricuspid valve regurgitation developed in 15 patients and progressive systemic right ventricle dysfunction developed in 3 patients. CONCLUSION: The results of conventional management were disappointing, with significant morbidity of tricuspid failure, right ventricle failure and conduction system failure. Anatomical repair of corrected TGA can be achieved with favorable immediate surgical results but long-term follow up will be necessary.