Download PDF
Thorac Cardiovasc Surg 2004; 52(3): 169-173
DOI: 10.1055/s-2004-820881
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Excision of the Coronary Orifices in Arterial Switch Operation: “O” Like Obstructive and “U” Like Unobstructive?[*]

W. Beierlein1 , H.-P. Freitag1 , S. Salehi-Gilani1 , R. Kaulitz2 , B. Pietsch3 , I. Luhmer4 , M. Hofbeck2 , G. Ziemer1
  • 1Department of Thoracic, Cardiac and Vascular Surgery, Tübingen University Hospital, Tübingen, Germany
  • 2Department of Pediatric Cardiology, Intensive Care Medicine and Pulmology, Tübingen University Hospital, Tübingen, Germany
  • 3Department of Medical Information Processing, Tübingen University Hospital, Tübingen, Germany
  • 4Department of Pediatric Cardiology, Medical School Hanover, Hanover, Germany
Further Information

Publication History

Received January 5, 2004

Publication Date:
11 June 2004 (online)

    Permissions and Reprints All articles of this category

Abstract

Background: Stenoses of the neo-pulmonary artery (NPA) may complicate follow-up of the arterial switch operation (ASO). It is unknown whether the type of patch covering the coronary excision defects (“O”- or “U”-shaped) might influence this complication. Methods: Echocardiographically and invasively measured NPA pressure-gradients were evaluated retrospectively in 95 children after ASO. Median follow-up was 5.8 years. Defects had been covered with pericardial patches: O/O and U/U (left/right) 34 × each, and 27 × in mixed combinations. The frequency of NPA stenoses requiring re-interventions was registered. Results: Median of the peak instantaneous echocardiographic pressure gradient was 23 mmHg (interquartile range, IQR: 16 - 49, n = 34) in O/O, and 19 mmHg (IQR: 13 - 23, n = 34) in U/U; p < 0.034, t-test. Invasively measured gradients were 49 mmHg (IQR: 17 - 65, n = 12) in O/O, and 12 mmHg (IQR: 7‐21, n = 28) in U/U; p < 0.001. One child per O/O- and U/U-group underwent balloon angioplasty of the neo-pulmonary root. Five children of the O/O-group had to undergo repeat surgery, whereas only one child in the U/U-group required repeat surgery (p < 0.34). Conclusions: The preferential type of covering the NPA coronary excision sites in ASO should be U‐shaped.

Key words

Arterial switch operation - pulmonary stenosis - coronary excision

1 The paper was presented at the 32nd Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery Leipzig, February 23 - 26, 2003

References

  • 1 Jatene A D, Fontes V F, Paulista P P. et al . Anatomic correction of transposition of the great vessels.  J Thorac Cardiovasc Surg. 1976;  72 364-370
    PubMedGoogle Scholar
  • 2 Yacoub M H, Radley-Smith R. Anatomy of the coronary arteries in transposition of the great arteries and methods for their transfer in anatomical correction.  Thorax. 1978;  33 418-424
    CrossrefPubMedGoogle Scholar
  • 3 Lecompte Y, Zannini L, Hazan E. et al . Anatomic correction of transposition of the great arteries.  J Thorac Cardiovasc Surg. 1981;  82 629-631
    PubMedGoogle Scholar
  • 4 Haas F, Wottke M, Poppert H, Meisner H. Long-term survival and functional follow-up in patients after the arterial switch operation.  Ann Thorac Surg. 1999;  68 1692-1697
    CrossrefPubMedGoogle Scholar
  • 5 Massin M M, Nitsch G B, Daebritz S, Seghaye M C, Messmer B J, von Bernuth G. Growth of pulmonary artery after arterial switch operation for simple transposition of the great arteries.  Eur J Pediatr. 1998;  157 95-100
    CrossrefPubMedGoogle Scholar
  • 6 Williams W G, Quaegebeur J M, Kirklin J W, Blackstone E H. Outflow obstruction after the arterial switch operation: a multi-institutional study. Congenital Heart Surgeons Society.  J Thorac Cardiovasc Surg. 1997;  114 975-987
    PubMedGoogle Scholar
  • 7 Sauer U, Gittenberger-de-Groot A C, Peters D, Bühlmeyer K. Cineangiography of the coronary arteries in transposition of the great arteries.  Pediatr Cardiol. 1983;  4 (SuppI) 25-42
    PubMedGoogle Scholar
  • 8 Hövels-Gürich H H, Seghaye M C, Ma Q. et al . Long-term results of cardiac and general health status in children after neonatal arterial switch operation.  Ann Thorac Surg. 2003;  75 935-943
    CrossrefPubMedGoogle Scholar
  • 9 Losay J, Touchot A, Serraf A. et al . Late outcome after arterial switch operation for transposition of the great arteries.  Circulation. 2001;  104 I121-I126
    PubMedGoogle Scholar
  • 10 Daebritz S H, Nollert G, Sachweh J S, Engelhardt W, von Bernuth G, Messmer B J. Anatomical risk factors for mortality and cardiac morbidity after arterial switch operation.  Ann Thorac Surg. 2000;  69 1880-1886
    CrossrefPubMedGoogle Scholar
  • 11 Spiegelenberg S R, Hutter P A, van-de-Wal H J, Hitchcock J F, Meijboom E J, Harinck E. Late re-interventions following arterial switch operations in transposition of the great arteries. Incidence and surgical treatment of postoperative pulmonary stenosis.  Eur J Cardiothorac Surg. 1995;  9 7-10
    CrossrefPubMedGoogle Scholar
  • 12 Schmaltz A A, Bein G, Grävinghoff L. et al . Balloon valvuloplasty of pulmonary stenosis in infants and children - co-operative study of the German Society of Pediatric Cardiology.  Eur Heart J. 1989;  10 967-971
    PubMedGoogle Scholar
  • 13 Quaegebeur J M, Rohmer J, Ottenkamp J. et al . The arterial switch operation. An eight-year experience.  J Thorac Cardiovasc Surg. 1986;  92 361-384
    PubMedGoogle Scholar
  • 14 Tang T, Chiu I S, Chen H C, Cheng K Y, Chen S J. Comparison of pulmonary arterial flow phenomena in spiral and Lecompte models by computational fluid dynamics.  J Thorac Cardiovasc Surg. 2001;  122 529-534
    CrossrefPubMedGoogle Scholar

1 The paper was presented at the 32nd Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery Leipzig, February 23 - 26, 2003

Prof. Dr. med. Gerhard Ziemer

Department of Thoracic, Cardiac and Vascular Surgery · Tübingen University Hospital

Hoppe-Seyler-Straße 3

72076 Tübingen

Germany

Phone: + 4970712986638

Fax: + 49 70 71 29 40 47

Email: gd.ziemer@uni-tuebingen.de

      >