Combined atrial and arterial switch operations for congenitally corrected transposition
Journal
Journal of the Formosan Medical Association
Journal Volume
100
Journal Issue
1
Pages
53-59
Date Issued
2001
Author(s)
Abstract
Conventional repair of congenitally corrected transposition of the great arteries (CCTGA) is directed at eliminating the associated defects and leaves the right ventricle in a systemic position. The long-term outcome of this procedure may involve deterioration of right ventricular function with tricuspid regurgitation and failure of the conduction system. We describe two consecutive patients with CCTGA, one of whom had apicocaval juxtaposition. The patients were aged 19 and 16 months, respectively, and both underwent a combination of atrial and arterial switch. These are the first two reported cases of successful completion of this type of operation in Taiwan. Our review of previously reported cases suggested that no significant difference exists in the outcome of patients with this condition who undergo either arterial switch or Rastelli-type repair plus atrial redirection. However, reported patients who underwent anatomic repair had lower early mortality, late mortality, and incidence of complete heart block than those who underwent conventional repair. The present two cases and our review of the literature suggest that, among patients with apicocaval juxtaposition, 1) Mustard operation is optimal for patients with small atrial volume; 2) one-and-one-half ventricular repair may be helpful to the outcome, especially when treatment is combined with Rastelli-type repair; and 3) excellent access to the ventricular septal defect through the tricuspid valve is afforded via a left atriotomy. From the present two cases and our review of the literature, we conclude that anatomic repair is superior to conventional repair of CCTGA in terms of protection against dysfunction and failure of the anatomic right ventricle, tricuspid valve, and conduction system. Long-term follow-up is mandatory.
SDGs
Other Subjects
artery surgery; article; atrioventricular conduction; case report; child; complete heart block; controlled study; follow up; great vessels transposition; heart right ventricle; heart right ventricle failure; heart right ventricle function; heart size; heart ventricle septum defect; human; incidence; intermethod comparison; medical literature; mortality; outcomes research; surgical approach; surgical technique; Taiwan; tricuspid valve regurgitation; Cardiac Surgical Procedures; Humans; Infant; Transposition of Great Vessels
Type
journal article