Intraoperative fluorescence angiography after arterial switch operation

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Neonatal Intensive Care

Background:

• d-transposition of the great arteries (dTGA) is a critical congenital heart defect.
• The arterial switch operation (ASO) is a standard surgical repair for dTGA.
• Intraoperative complications, such as mitral regurgitation (MR), can occur during ASO.

Purpose of the Study:

• To report a successful arterial switch operation with the LeCompte maneuver in a neonate with dTGA and intact ventricular septum.
• To evaluate the utility of intraoperative transesophageal echocardiography and indocyanine green (ICG) angiography in assessing surgical outcomes.
• To document the resolution of post-operative mitral regurgitation.

Main Methods:

• Successful arterial switch operation with the LeCompte maneuver was performed.
• Intraoperative transesophageal echocardiography was used to assess mitral regurgitation.
• Indocyanine green angiography was utilized to visualize reconstructed coronary arteries.

Main Results:

• The arterial switch operation was technically successful.
• Moderate mitral regurgitation was noted immediately after cardiopulmonary bypass weaning.
• Indocyanine green angiography provided clear visualization of the reconstructed coronary arteries.
• Mitral regurgitation significantly improved before the patient's transfer to the ICU.

Conclusions:

• The arterial switch operation with the LeCompte maneuver is an effective treatment for dTGA in neonates.
• Indocyanine green angiography is a valuable tool for intraoperative assessment of coronary artery reconstruction.
• Spontaneous resolution of post-operative mitral regurgitation is possible.