Physiologic versus anatomic repair of congenitally corrected transposition of the great arteries

2003 ◽  
Vol 6 (1) ◽  
pp. 16-26 ◽  
Author(s):  
Constantine Mavroudis ◽  
Carl L. Backer
Keyword(s):  
Anatomic Repair ◽  
Congenitally Corrected Transposition ◽  
Corrected Transposition

scholarly journals Senning with Aortic Translocation, Anatomic Repair for Congenitally Corrected Transposition

2020 ◽  
Author(s):  
Vincent KH. Tam ◽  
Eldad Erez ◽  
Lisa Roten ◽  
Steve Muyskens ◽  
Vinod Sebastian ◽  
...  
Keyword(s):  
Anatomic Repair ◽  
Congenitally Corrected Transposition ◽  
Corrected Transposition

scholarly journals Effectiveness of Bidirectional Glenn Shunt Placement for Palliation in Complex Congenitally Corrected Transposed Great Arteries

2020 ◽  
Vol 47 (1) ◽  
pp. 15-22
Author(s):  
Kai Ma ◽  
Lei Qi ◽  
Zhongdong Hua ◽  
Keming Yang ◽  
Hao Zhang ◽  
...  
Keyword(s):  
Glenn Shunt ◽  
Shunt Placement ◽  
Anatomic Repair ◽  
Bidirectional Glenn ◽  
Palliative Procedure ◽  
Bidirectional Glenn Shunt ◽  
Group 3 ◽  
Congenitally Corrected Transposition ◽  
Corrected Transposition

Surgery for complex congenitally corrected transposed great arteries is one of the greatest challenges in cardiovascular surgery. We report our experience with bidirectional Glenn shunt placement as a palliative procedure for complex congenitally corrected transposition. We retrospectively identified 50 consecutive patients who had been diagnosed with congenitally corrected transposition accompanied by left ventricular outflow tract obstruction and ventricular septal defect and who had then undergone palliative bidirectional Glenn shunt placement at our institution from January 2005 through December 2014. Patients were divided into 3 groups according to subsequent surgeries: Fontan completion (total cavopulmonary connection, 13 patients) (group 1), anatomic repair (hemi-Mustard and Rastelli procedures without Glenn takedown, 11 patients) (group 2), and prolonged palliation (no further surgery, 26 patients) (group 3). After shunt placement, no patient died or had ventricular dysfunction. Overall, mean oxygen saturation increased significantly from 79.5% ± 13.5% preoperatively to 94.1% ± 7.3% (P <0.001). The median time from shunt placement to Fontan completion and anatomic repair, respectively, was 2.1 years (range, 1.6–5.2 yr) and 1.1 years (range, 0.6–2.4 yr). Only 2 late deaths occurred, both in group 1. In group 3, time from shunt placement to latest follow-up was 4.5 years (range, 2.3–8 yr). At latest follow-up, mean oxygen saturation was 91.6% ± 10.3%, and no patients had impaired ventricular function. Bidirectional Glenn shunt placement as an optional palliative procedure for complex congenitally corrected transposition has favorable outcomes. Later, patients can feasibly be treated by Fontan completion or anatomic repair. Use of a bidirectional Glenn shunt for open-ended palliation is also acceptable.

Management of Congenitally Corrected Transposition of the Great Arteries With Intact Ventricular Septum: Anatomic Repair or Palliative Treatment?

2021 ◽  
Author(s):  
Hujun Cui ◽  
Ali Hage ◽  
Breanna L. Piekarski ◽  
Gerald R. Marx ◽  
Christopher W. Baird ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Right Ventricle ◽  
Ventricular Dysfunction ◽  
Ventricular Septum ◽  
Composite Outcome ◽  
Intact Ventricular Septum ◽  
Single Institution ◽  
Anatomic Repair ◽  
Congenitally Corrected Transposition ◽  
Corrected Transposition

Background: Management of the congenitally corrected transposition of the great arteries (ccTGA) with intact ventricular septum (IVS) is controversial and includes either anatomic repair with systemic left ventricle (morphological left ventricle) or maintenance of a systemic right ventricle (morphological right ventricle). The purpose of this study was to describe outcomes of ccTGA-IVS with either strategy. Methods: A single-institution, retrospective review of all patients with a diagnosis of ccTGA-IVS who either underwent double switch operation (DSO) or managed with systemic morphological right ventricle (no-DSO). The composite end points included death, heart transplantation, or development of significant systemic ventricular dysfunction or atrioventricular valve regurgitation. Results: Between January 1980 and October 2019, 128 patients with ccTGA-IVS underwent primary treatment at a single institution (91 no-DSO and 37 DSO). Mean age at initial presentation was younger in the DSO compared with the no-DSO cohort (2.1 versus 18.2 years; P <0.001). Fifty patients underwent pulmonary artery banding (35 DSO and 15 no-DSO). In the no-DSO cohort, the overall mortality was 5.5% (n=5), 17.6% (n=16) developed morphological right ventricular dysfunction, and 40.7% (n=37) required pacemaker. In the DSO cohort, mortality was 2.7% (n=1), 8.1% (n=3) developed morphological left ventricular dysfunction, and 43.6% (n=16) required pacemaker. Freedom from composite end point at 5 and 10 years was 88% and 87% in the no-DSO compared with 94% and 84% in the DSO cohort. The DSO cohort had 0.29× the hazards of developing the composite outcome compared with the no-DSO cohort (hazard ratio, 0.29 [95% CI, 0.089–0.94]; P =0.039). Among patients with initial age at presentation ≤5 years, DSO was associated with 0.16× the hazard compared with no-DSO (hazard ratio, 0.16 [95% CI, 0.04–0.62]; P =0.008). Pacemaker implantation was not associated with increased hazard of the composite outcome. Conclusions: Systemic ventricular dysfunction is a late complication of ccTGA-IVS regardless of the strategy pursued. Compared with those undergoing anatomic repair, patients with systemic morphological right ventricle may have lower long-term freedom from cardiovascular complications.

Abstract 14198: Anatomic Repair of Congenitally Corrected Transposition of the Great Arteries is Associated With Significant Mid- and Long-term Electrophysiologic Morbidity

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Rebecca R Hartog ◽  
Kimberly J Watkins ◽  
Megan Wilde ◽  
Tiffany R Lim ◽  
Andrew Rodenbarger ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Pulmonary Stenosis ◽  
Cox Proportional Hazards ◽  
Anatomic Repair ◽  
Atrial Switch ◽  
Increased Risk ◽  
Congenitally Corrected Transposition ◽  
Corrected Transposition

Introduction: Limited data exist on the electrophysiologic outcomes of patients undergoing anatomic repair (AR) for congenitally corrected transposition of the great arteries (ccTGA). AR was defined as an atrial switch procedure plus either arterial switch (ASO) or Rastelli operation. Aims: To report mid and late electrophysiologic outcomes after AR and identify risk factors for those outcomes. Methods: Single center retrospective cohort study of patients undergoing AR between 1993-2017. Data were collected from available records. Transplant-free survival to 1 year post repair was required for inclusion. Standard descriptive statistical analysis and Cox proportional hazards were used. Results: Of 85 patients included, 95% had lesions in addition to ccTGA: most commonly VSD (84%) and pulmonary stenosis or atresia (58%). Median age at AR was 1.5y (IQR 0.9-2.8) with Senning/ASO in 56%, Senning/Rastelli in 38%, and hemi-Senning/Glenn/Rastelli in 6%. During a median follow-up of 10.6y, 45 (53%) patients developed an arrhythmia requiring intervention. Atrial tachycardia (AT) in 27 (32%) or ventricular tachycardia (VT) in 11 (13%) patients required intervention at a median of 7.4y (IQR 1.6-15.3y) and 15.9y (IQR 4.5-17.9) post-AR, respectively. Treatments included chronic medications in 29 (64%), cardioversion in 15 (33%) and catheter ablation in 10 (22%). Median freedom from AT and VT was 17.3y and 25y post-AR, respectively. D-looped ventricles (p=0.03) and multiple operations prior to AR (p=0.02) were associated with increased AT risk; and native pulmonary stenosis with increased VT risk (p=0.01). Those needing heart failure/transplant referral had increased risk of both AT and VT (both p=0.04). Pacemaker was implanted for heart block and/or SND prior to or during AR in 14 (16%), immediately post-op in 9 (11%), and late (median 6y post-AR) in 24 (28%). ICDs were implanted in 5 (6% of cohort), 4 for primary prevention. No patient had an appropriate shock. Conclusions: Anatomic ccTGA repair is associated with significant electrophysiologic morbidity. AT, VT, and SND develop at a similar incidence to that reported for d-TGA patients after atrial switch. The incidence of AV block follows a similar trajectory to that of physiologically palliated ccTGA.

scholarly journals Congenitally corrected transposition of great arteries: a case series of five unoperated African children

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Bernard Obongonyinge ◽  
Judith Namuyonga ◽  
Hilda Tumwebaze ◽  
Twalib Aliku ◽  
Peter Lwabi ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tricuspid Valve ◽  
Pulmonary Stenosis ◽  
Valve Regurgitation ◽  
Ventricular Failure ◽  
Tricuspid Valve Regurgitation ◽  
Transposition Of Great Arteries ◽  
Anatomic Repair ◽  
Congenitally Corrected Transposition ◽  
Corrected Transposition

Abstract Background Congenitally corrected transposition of great arteries (ccTGA) is rare. It is commonly associated with ventricular septal defect (VSD), pulmonary stenosis and heart block. Early anatomic repair is recommended between 3 and 6 months of age to prevent development of tricuspid valve regurgitation and systemic right ventricular failure. Case presentation We retrospectively identified five cases of ccTGA. Cases were between one and 13 years of age. All the cases were unoperated. Four of the five cases had associated intracardiac defects/complications. These included: VSD, pulmonary stenosis, tricuspid valve regurgitation, right ventricular systolic dysfunction and heart block. Conclusion These cases demonstrate the challenges of access to early diagnosis and surgery in a low resource setting. This delay in anatomic repair leads to complications of tricuspid valve regurgitation and systemic right ventricular failure.

P2 Outcomes in adults following anatomic repair of congenitally corrected transposition of the great arteries

Heart ◽  
2016 ◽  
Vol 102 (Suppl 1) ◽  
pp. A1.2-A1
Author(s):  
Sayqa Arif ◽  
Sarah Bowater ◽  
Paul Clift ◽  
Sara Thorne ◽  
Lucy Hudsmith
Keyword(s):  
Anatomic Repair ◽  
Congenitally Corrected Transposition ◽  
Corrected Transposition
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