Adequate left ventricular preparation allows for arterial switch despite late referral

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Echocardiography

Background:

• Transposition of the great arteries (TGA) involves complex heart defects requiring timely intervention.
• Late referral in TGA cases presents challenges due to potential left ventricular underdevelopment.
• Surgical repair aims to correct the anatomical abnormalities and restore normal blood flow.

Purpose of the Study:

• To assess the feasibility of the arterial switch procedure for TGA in patients with late referral.
• To evaluate the effectiveness of left ventricular preparation strategies prior to surgery.
• To monitor changes in left ventricular morphology and function using echocardiography.

Main Methods:

• Retrospective analysis of six infants with TGA undergoing arterial switch after left ventricular preparation.
• Pre-operative interventions included atrial communication creation, pulmonary artery banding, and shunt placement.
• Echocardiography was used to assess left ventricular dimensions, wall thickness, ejection fraction, and shortening fraction.

Main Results:

• All six patients survived the arterial switch procedure with a mean follow-up of 17 months.
• Significant reduction in the right to left ventricular wall thickness ratio was observed post-preparation (p < 0.005).
• Adequate left ventricular function was confirmed post-surgery, with mean ejection fraction of 79.3% and shortening fraction of 41.7%.

Conclusions:

• The arterial switch procedure can be successfully performed in TGA patients despite late referral and initial left ventricular inadequacy.
• Pre-operative left ventricular preparation is crucial for successful surgical outcomes.
• Echocardiography plays a vital role in monitoring ventricular adaptation and guiding surgical timing.