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The vectorcardiogram in 4 children undergoing the arterial switch repair
L V Fong1, B D Edis, A W Venables
1Department of Cardiology, Royal Children's Hospital, Victoria, Australia.
Insights
Vectorcardiograms did not predict left ventricular preparedness for arterial switch repair in children with complete transposition. This study found vectorcardiograms were not useful for assessing suitability for this complex cardiac surgery.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Complete transposition of the great arteries (TGA) involves discordant ventriculo-arterial connections.
- Delayed arterial switch repair is a surgical option for TGA, sometimes following prior palliative procedures.
- Assessing ventricular readiness for arterial switch repair is critical for surgical success.
Purpose of the Study:
- To evaluate the utility of pre-operative vectorcardiograms in assessing left ventricular preparedness for arterial switch repair in children with TGA.
- To determine if vectorcardiographic parameters correlate with ventricular pressure ratios or surgical survival.
Main Methods:
- Retrospective analysis of 4 children with TGA undergoing arterial switch repair.
- Pre-operative vectorcardiograms were analyzed.
- Cardiac catheterization data was reviewed to assess ventricular pressure ratios.
- Surgical outcomes, including survival, were recorded.
Main Results:
- Vectorcardiograms were performed before arterial switch repair in 4 children.
- Left maximal spatial voltage did not correlate with elevated ventricular pressure ratios or survival.
- All patients exhibited a clockwise horizontal loop on pre-operative vectorcardiograms.
Conclusions:
- Vectorcardiography is not a reliable indicator of left ventricular preparedness for arterial switch repair in this pediatric TGA cohort.
- Further research is needed to identify reliable methods for assessing ventricular suitability prior to arterial switch surgery.
Abstract:
Four children with complete transposition (concordant atrioventricular and discordant ventriculo-arterial connections), aged 1.2 to 16.4 years, underwent a delayed repair by the arterial switch procedure from March 1985 to October 1986. Three children had undergone previous atrial diversion repairs in early childhood. Two of these children had developed right ventricular dysfunction with tricuspid incompetence as well as having recurrent and symptomatic supraventricular tachyarrhythmias. They underwent banding of the pulmonary trunk 0.7 and 1 year prior to the final repair. The third child had dynamic obstruction of the left ventricular outflow tract and prior banding was not performed. A fourth child had right ventricular dysfunction on initial assessment in early infancy and then had banding of the pulmonary trunk. Two patients survived the arterial switch operation. Vectorcardiograms were performed on these 4 children before arterial switch repair. The left maximal spatial voltage did not correlate with elevated left to right ventricular pressure ratio at cardiac catheterization before arterial switch repair nor did it relate to survival after operation. The horizontal loop was clockwise in all patients preoperatively. The vectorcardiogram in these children was not a useful indicator that the left ventricle was suitably prepared for the arterial switch repair.