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Left ventricular outflow tract obstruction after arterial switch operation.

Bertrand Léobon1, Emre Belli, Mohammed Ly

  • 1Department of Pediatric Cardiac Surgery, Centre Chirurgical Marie-Lannelongue, Le Plessis-Robinson, France.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|October 3, 2008
PubMed
Summary

Postoperative left ventricular outflow tract obstruction (LVOTO) after arterial switch operation (ASO) is rare, particularly in Taussig-Bing anomaly. Most cases benefit from surgical correction, though complex cases may require iterative procedures and risk complications.

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Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • Postoperative left ventricular outflow tract obstruction (LVOTO) following arterial switch operation (ASO) is an uncommon complication.
  • Patients with Taussig-Bing anomaly (TBA) appear to have a higher incidence of LVOTO post-ASO.

Purpose of the Study:

  • To review cases of LVOTO after ASO.
  • To analyze correction options and patient outcomes for postoperative LVOTO.

Main Methods:

  • Retrospective review of 10 patients with LVOTO post-ASO from a cohort of 1689 ASO procedures.
  • Analysis of pre-ASO anatomical features and post-ASO interventions for LVOTO.

Main Results:

  • LVOTO developed between 5 months and 14 years post-ASO, necessitating reoperation in all 10 patients.
  • Most LVOTOs were due to fibrotic membranes or fibro-muscular hypertrophy, successfully treated with initial reoperation in 70% of patients.
  • Three patients required iterative surgical procedures, including aortic valve replacement or Konno procedures, with associated complications.

Conclusions:

  • Postoperative LVOTO after ASO is rare but more frequent in TBA.
  • Surgical resection of subaortic obstacles and septal plasties are effective for most LVOTOs.
  • Complex cases may necessitate iterative procedures, increasing the risk of complications like heart block or severe aortic regurgitation.