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[Transposition of the great arteries. Its anatomical correction. Our initial experience]
C Barriuso1, J Mulet, C Mortera
1Servicio de Cirugía Cardiovascular, Hospital Clínic i Provincial, Facultad de Medicina, Barcelona.
Insights
Arterial switch repair for transposition of the great arteries (TGA) showed zero mortality in 8 pediatric patients. This arterial switch procedure is recommended as the primary treatment for TGA.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Great Arteries Anatomy
Context:
- Transposition of the great arteries (TGA) is a critical congenital heart defect.
- Surgical correction is essential for survival and quality of life.
- Previous palliative procedures like pulmonary artery banding and Blalock-Taussig shunts were noted in some patients.
Purpose:
- To evaluate the safety and efficacy of the arterial switch procedure in pediatric patients with TGA.
- To assess the outcomes of the arterial switch procedure using specific surgical techniques.
- To determine the feasibility of the arterial switch procedure as a primary treatment for TGA.
Summary:
- The arterial switch procedure was performed on 8 children (7 neonates, 1 six-year-old) with TGA, achieving 100% survival.
- The "trap-door" technique for coronary anastomosis and the Lecompte manoeuvre were utilized.
- Postoperative management focused on persistent pulmonary hypertension and left ventricular dysfunction, with all patients discharged in stable condition.
Impact:
- The arterial switch procedure demonstrates excellent short-term outcomes in pediatric TGA patients.
- This study supports the arterial switch procedure as the preferred initial surgical approach for TGA.
- Successful outcomes encourage wider adoption of this technique in managing TGA.
Abstract:
Arterial switch correction of transposition of the great arteries has been performed without mortality on 8 children, 7 neonates and one 6 years old child, at our institution. One infant and the 6 year old child has previous pulmonary artery banding and modified Blalock-Taussig shunts. The coronary cuffs were anastomosed to the neo-aorta using the "trap-door" technique described by Mee and in seven the Lecompte manoeuvre was used. Postoperative management included treatment for persistent pulmonary hypertension and left ventricular dysfunction. All patients were discharged in satisfactory condition, and continue to do so at a maximum follow-up of ten months. These results encourage us to elect the arterial switch procedure as the primary treatment of transposition of the great arteries.