Serial echocardiography for decision making in rapid two-stage arterial switch operation

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Echocardiography in Cardiac Surgery

Background:

• Late presentation of simple transposition in infants necessitates effective left ventricular (LV) preparation for arterial switch operation (ASO).
• The efficacy of echocardiography alone in guiding surgical decisions for ASO remains uncertain.

Purpose of the Study:

• To evaluate the reliability of echocardiography in assessing left ventricular preparation for rapid two-stage arterial switch operation (ASO).
• To identify echocardiographic parameters that predict successful ASO outcomes in infants with simple transposition.

Main Methods:

• Seventeen infants with simple transposition underwent a two-stage procedure: pulmonary artery banding and modified Blalock-Taussig shunt, followed by ASO.
• Serial echocardiography was used to monitor LV growth and morphology during the interval phase.
• Surgical outcomes, including mortality and conversion rates, were analyzed.

Main Results:

• Significant increases in LV mass (40.8 to 81.4 g/m2), posterior wall thickness (3.37 to 4.63 mm), and end-diastolic diameter were observed.
• Successful ASO cases showed a circular LV shape with synchronized interventricular septal contraction.
• Two cases failed ASO, characterized by a flat interventricular septum.

Conclusions:

• Echocardiography is a reliable tool for surgical decision-making in rapid two-stage ASO.
• Predictors of successful ASO include increased LV mass, wall thickness, end-diastolic diameter, a circular LV shape, and synergistic septal contraction.