Medical disease and differential diagnosis what is transposition of the great arteries tga. We track outcomes from common procedures as quality indicators for congenital heart surgery. Transposition of the great arteries and the arterial. Arterial switch operation, which is another common and effective surgical procedure, is usually most often performed during the infants early months of his or her life. Double outlet right ventricle dorv, as depicted in the image below, is a type of ventriculoarterial connection in which both the aorta ao and pulmonary artery pa arise entirely or predominantly from the right ventricle rv. The arterial switch operation is the most common operation to correct tga as of 2016. Arterial switch operation patients uncommonly develop arrhythmia, with no more than 5% experiencing difficulties.
Grownup congenital heart disease guch textbook of cardiology. The only outlet from the left ventricle lv is a ventricular septal defect vsd. The incidence is estimated at 1 in 3,5005,000 live births, with a maletofemale ratio 1. Transposition of the great arteries orphanet journal of rare. Transposition of the great arteries is a condition where that the two main blood vessels leaving the heart, the pulmonary artery which takes blood to the lungs to pick up oxygen and the aorta which takes blood from the heart to the body are swapped over switched. Historical evolution of surgery for transposition of great arteries. No guidelines exist for the management of acute or chronic ischemia in this setting. The left and right coronary artery ostia are visualized and excised from the aortic root with adjacent aortic wall as buttons.
Regina mcelroy director office of transportation management notice this document is disseminated under the sponsorship of the u. Jun 07, 2012 the arterial switch operation is a simple concept. Late complications following the arterial switch operation. The lecompte maneuver is a technique used in open heart surgery, primarily on infants and children. The aorta is cannulated near the base of the innominate artery, and both the superior and inferior vena cava have been separately cannulated.
Cardiovascular outcomes after the arterial switch operation. The arterial switch operation is aimed at normalizing ventriculoarterial concordance. Typical anatomy and cannulation for the arterial switch operation for simple transposition of the great arteries. The longterm survival 20 years after discharge is about 95 and 80 percent for arterial switch and atrial switch respectively. The arterial switch operation 19541975 the embryo project. In most patients, the anomalous left coronary artery is situated in a position that allows for direct transfer of the anomalous.
Mortality is higher when there are additional defects like a hole in the heart vsd or narrowing of the arteries to the body aorta. Check out these bestsellers and special offers on books and newsletters from mayo clinic. A history of german measles rubella or another viral illness in the. Transposition of the great arteries childrens hospital. The atrial switch operation was developed by the efforts of many surgeons, with the most notable contributions made by blalock, hanlon, albert, baffes, senning, and mustard. Arterial switch operation or arterial switch, is an open heart surgical procedure used to correct. To evaluate the early and medium term results of operations for congenitally corrected transposition of the great arteries cctga wherein the left ventricle becomes the systemic ventricle. Jacobs1 forty years ago, when adib jatene, in sao paulo, brazil performed the first successful arterial switch operation on an infant with transposition of the great ar. The difficulty with this operation is the coronary arteries. Surgical mortality during this period was analyzed retrospectively. Permanent treatment requires a surgical procedure to switch the arteries to their proper places.
The modern repair that is preferred is called the arterial switch operation aso for short. Less than 2% develop complete heart block, most of whom had a ventricular septal defect in addition to the transposition. The eventually successful solution in the form of the now popular arterial switch operation aso was elucidated after multiple contributions. The procedures are described in laymans terms, translated to icd10pcs root operation terminology, and the corresponding root operation tables are. During the aso, the surgeon will transect both the pulmonary trunk and aorta then translocate them to their anatomically correct positions. The arterial switch operation is the procedure of choice for correction of transposition of the great arteries. Outcome in adult patients after arterial switch operation for. Then, when libby was 74 days old and just over 5 pounds, dr. Outcomes of patients after arterial switch operation. This operation, called an arterial switch operation, is done within the first few weeks of life. Arterial switch operation or arterial switch, is an open heart surgical procedure used to correct dextrotransposition of the great arteries dtga. Definition and epidemiology, etiology, pathophysiology, clinical features, investigations, diagnosis. The small coronary arteries, which feed the heart muscle with blood, need to be transferred as well as the two great arteries aorta and pulmonary artery.
Lung transplant for pulmonary arterial hypertension after. Therefore, from the 1960s to the 1980s, venous switch surgeries became the dominant treatment method for transposition of the great arteries. Usually, the jatene arterial switch operation is the procedure of choice. Transposition of the great arteries the patient guide to. The journal of thoracic and 672 brief communications.
Daniel t, jokhadar m, sahu a, kogon b, konno aortoventriculoplasty following arterial switch operation requires pulmonary valve disruption and right ventricular outflow tract reconstruction. The aso remains a major, complex cardiac operation that is performed in the first few weeks of life and requires surgeons specifically trained in such newborn repairs. The longterm survival rates for patients with dtga following surgical correction are excellent for both arterial switch operation and atrial switch procedures. However, the term transposition was only applied in 1814, by farre, meaning that aorta and pulmonary trunk were placed positio across trans the ventricular septum. Although offering excellent long term results, this procedure is burdened by the risk of acute and subacute coronary occlusion. First successful arterial switch operation for transposition of the great vessels tgv 1978. Sep 10, 20 outcome in adult patients after arterial switch operation for transposition of the great arteries. Arterial switch operation for tga restores the left ventricle as systemic ventricle operative mortality now book provides a comprehensive overview of exercise physiology in patients with congenital heart disease and other pediatric cardiopulmonary disorders. It is an openheart procedure that requires a temporary stopping of the babys heart while a heartlung machine handles respiration and blood circulation. Transposition of the great arteries statpearls ncbi.
Fbn 2459 and the north carolina nurses association. Past, present, and future of the arterial switch operation. For babies with heart defects, death risk is far lower at. Transposition of the great arteries symptoms and causes mayo. The objective of this paper was to describe the outcomes in patients submitted to arterial switch operation and to analyze the predictors of inhospital mortality and further need of re operation at a singlecenter institution. When the infant is about one week old, an arterial switch operation is performed which corrects the defect by connecting the aorta to the left ventricle and the pulmonary artery to the right ventricle, as in a normal heart see animation at right. Jatene procedure project gutenberg selfpublishing ebooks.
Congenitally corrected transposition of the great arteries cctga can occur in isolation, or in combination with other structural cardiac anomalies, most commonly ventricular septal defect, pulmonary stenosis and tricuspid valve disease. We report successful lung transplantation in a case of pulmonary hypertension after arterial switch operation. The society of thoracic surgeons sts congenital heart surgery database shows an expected outcome of 1. Aug 15, 2008 attempts at the arterial switch operation predated the senning and the mustard venous switch procedures. This desk reference is organized by common procedure nomenclature used in the hospital setting, which is linked to the related root operation tables. Postoperative management of the arterial switch operation for the great arteries in chapter 18 from cardiac anesthesia. The science and art of cardiac surgery has made rapid strides in the past 65 years.
Arterial switch to 12 oclock associated with reduced coronary reserve in adolescence. Between september 1995 and january 2014, 128 consecutive arterial switch operations were performed. It is for this reason that the operation is performed in the newborn period while the left ventricle remains adequately prepared to support the systemic circulation. Transposition of the great arteries, dtype congenital. An arterial switch operation is an openheart procedure. Early surgery is essential and involves the arterial switch operation, which is carried out in the first week or two of life and corrects the abnormality. This chapter includes a recommendation that evaluation for disability due to congenital heart disease be divided into four age groupings consistent with the changed timing of surgery for these defects and the developmental capacities of these age groups. Arrythmias chronotropic impairment found consistently postaso associated with residual hemodynamic lesions or cad late postoperative atrial flutter or fibrillation, is associated with rvot obstruction khairy p et al. The experience gained in coronary artery transfer during the arterial switch operation has facilitated techniques for coronary transfer to repair the alcapa. Arterial switch operation for dtga by dr attawar sandeep. The arterial switch operation aso has replaced atrial switch.
Mustard attempted his version of the arterial switch operation in 1954 on. Cardiovascular outcomes after the arterial switch operation for d. Surgical approach to anomalous left coronary artery from. Babies born with transposition of the great arteries undergo arterial switch in first days of life. Fourteen patients with cctga who underwent anatomic repair from 1994 to 1998 were placed in one of two groups. Double switch for congenitally corrected transposition of. Cedars 2015 primary prevention of sudden cardiac death in adults with transposition of the great arteries. It is used to correct many forms of transposition of the great arteries, a congenital heart defect in which the aorta and the pulmonary artery are reversed. Kempny a1, wustmann k, borgia f, dimopoulos k, uebing a, li w, chen ss, piorkowski a, radleysmith r, yacoub mh, gatzoulis ma, shore df, swan l, diller gp. William mcmahon, a pediatric interventional cardiologist, successfully performed a balloon atrial septostomy, which allowed libbys oxygen levels to stabilize.
Cardiac outcomes in young adult survivors of the arterial. Department of transportation in the interest of information exchange. Adib jatene developed the arterial switch operation in 1975 in sao paulo, brazil. What are the longterm outcomes after the arterial switch operation aso for dtransposition of the great arteries dtga. Program world society for pediatric and congenital heart. Pulmonary arterial hypertension and neonatal arterial. The arterial switch procedure requires cardiopulmonary bypass and aortic cross clamping. Patients with these conditions rarely have longterm sequelae after surgical correction in childhood. There are few reports of the appearance of pulmonary arterial hypertension following arterial switch surgery in the neonatal period to correct transposition of the great arteries. Van praagh r, jung wi the arterial switch operation in transposition of the great arteries.
Objectives we sought to determine cardiac outcomes in young adults with complete transposition of the great arteries tga after the arterial switch operation aso. Pulmonary arterial hypertension after arterial switch operation for transposition of the great arteries is an infrequent but lifethreatening complication. The aorta and the pulmonary artery are transected above the valves, moved to the correct position, and sewn in place. The jatene procedure, or arterial switch, is an open heart surgical procedure used to correct dextrotransposition of the great arteries dtga. Supra pulmonary stenosis after arterial switch operation for transposition of the great arteries.
Orlando regional healthcare is an approved provider of continuing nursing education by florida board of nursing provider no. Our patient stories birmingham, alabama al childrens. Now reflecting recent significant changes in the field, critical heart disease in infants and children, 3rd edition, keeps you abreast of the skills and knowledge required to safely care for children with congenital and acquired heart disease in the icu. Guidelines are no substitutes for textbooks, primary literature sources. Arterial switch, atrial switch, congenital heart disease, history of openheart surgery, transposition of great arteries. Longterm outcomes of the neoaorta after arterial switch operation for transposition of the great arteries. The human heart was considered a surgical untouchable for most part of scientific history. Cto of the lad in a young adult after the arterial switch. The operation was the first to realign the vessels incorrect anatomical position. Surgery is the mainstay of treatment for congenital heart disease, and the expected results can be classified as follows. Arterial switch, atrial switch, congenital heart disease, history of open heart surgery, transposition of great arteries. The coronary arteries are reimplanted into the neoaorta.
It was the first method of dtga repair to be attempted, but the last to be put into regular use because of technological limitations at the time of its conception. A 19yearold man had undergone the arterial switch operation with ventricular septal defect vsd repair in infancy but was lost to followup, returning to medical attention desiring clearance prior to becoming a forest ranger. Jan 06, 2017 this video shows the repair of a newborn with transposition of the great arteries and ventricular septal defect by means of arterial switch and vsd closure. The arterial switch procedure, also known as the jatene switch procedure, is an intervention designed to correct dtransposition of the great arteries dtga at the level of the aorta and main pulmonary artery. Arterial switch operation definition of arterial switch. Although the arterial switch is a major surgical procedure, the results are excellent. T1 late complications following the arterial switch operation. Medical treatment of transposition of the great arteries before surgery. Critical heart disease in infants and children by ross m. Background although cardiac outcomes in the pediatric population with tga after aso have been well described, outcomes in the adult population have not to our knowledge been studied. The maneuver entails cutting the main pulmonary artery and moving it anterior to the aorta before reattaching the pulmonary artery during the following reconstruction of the great vessels. Methods and resultsa singleinstitution retrospective cohort.
The following data show childrens hospital of philadelphia s chop outcomes for the arterial switch operation, for the repair of transposition of the great arteries. Clinical recognition can be challenging, so echocardiography is often the means by which definitive diagnosis is made. The surgery, known as the arterial switch operation, is typically performed within a few days of birth. Ninetynine percent of the surgeries are successful. Transposition of the great arteries in chapter 14 from a practical approach to cardiac anesthesia.
The arterial switch operation is appropriate treatment for most forms of transposition of the great arteries. The perinatal circulation and aortopulmonary transposition. The transposition of the great arteries was first described by mathew baillie in 1797, in the second edition of the book the morbid anatomy of some of the most important parts of the human body. Following aortic cross clamping, the ascending aorta and main pulmonary artery are transected. Neoaortic regurgitation in patients with transposition long term after an arterial switch operation and its relation to the root diameters and surgical technique used krzysztof w. This operation will require the use of cardiopulmonary bypass heartlung machine.
Diagnosis involves careful history taking and physical examination of the. Contemporary management and outcomes in congenitally. In this surgical operation, the aorta and pulmonary artery are both moved to their normal position. Oct, 2008 transposition of the great arteries tga, also referred to as complete transposition, is a congenital cardiac malformation characterised by atrioventricular concordance and ventriculoarterial va discordance. The arterial switch operation before jatene springerlink. It is performed early in life and includes switching of the aorta and coronary arteries from the systemic rv and of the pa from the lv and reattaching both great arteries to the appropriate ventricles. The corresponding rates for 17 children with isolated taussigbing anomaly were 81% and 100%. Backgrounddata regarding longterm outcomes after the arterial switch operation for dtransposition of the great arteries are scarce. With this article, you will be perfectly prepared for test questions concerning the classification and management of the congenital heart disease. Congenital heart disease chd classification and management.
The brazilian cardiac surgeon, adib jatene, reported the first successful arterial switch. Transposition of the great arteries orphanet journal of. Transposition of the great arteries 25 years after. No patients survived the earlier arterial switch methods. Clinical guidelines for the management of patients with transposition. Arterial switch operation and ventricular septal defect repair, norwood procedure, glennhemifontan, fontan, truncus repair, complete atrioventricular canal repair, and tetralogy of fallot repair. N2 the arterial switch operation has been the principal treatment for transposition of the great arteries and its variants for the last 25 years. Arterial switch operation for dtga by dr attawar sandeep g.
Common coronary artery arrangements in dtga anatomy of the coronary arteries in tga and methods for their transfer in anatomic correction. The arterial switch operation is the standard procedure for patients with dtga without major pulmonic stenosis. The arterial switch operation, also called the jatene procedure, is an. These conditions are patent ductus arteriosus, secundum atrial defect, and uncomplicated ventricular septal defect. Pediatric cardiothoracic surgery arterial switch operation. Transposition of the great arteries and the arterial switch. Surgeons reconstruct the heart so that the aorta is attached to the left ventricle and the pulmonary artery is attached to the right ventricle.
It allows the surgeon to reconstruct the right ventricular outflow tract without needing to connect the. Natural history of transpo sition of the great arteries. In 50% of cases, the va discordance is an isolated finding. Cardiopulmonary bypass outflow was established through the right subclavian and femoral arteries because of the previous arterial. Transposition of the great arteries great ormond street. Double outlet right ventricle with transposition clinical. The first book on fetalmaternal and neonatal physiology. The cost of surgical procedure for the treatment of total anomalous pulmonary venous connection repair or tapvc repair will be more than a general openheart surgery and will change according to the following.
Cardiovascular outcomes after the arterial switch operation for d transposition of the great arteries. Arterial switch operation or arterial switch, is an open heart surgical procedure used to correct dextrotransposition of the great arteries. Transposition of the great arteries is a serious but rare heart defect. Arterial switch to 12 oclock associated with reduced. Highrisk patients with a history of atypical, intramural, or problematic coronary. The role of myocardial perfusion scintigraphy and echocardiographic wallmotion analysis in the postoperative assessment of patients after the arterialswitch operation. Each visit should include history taking, clinical examination, 12lead. Covu jg, ginde s, bartz pj, frommelt pc, tweddell js, earing mg ann thorac surg 20 may. That surgery lasted until 1998 when it was replaced with the arterial switch operation. Arterial switch procedure radiology reference article. Anomalous left coronary artery from the pulmonary artery. This timeline lists prominent names, accomplishments, and events in the history of newborn medicine. Mortality rates ranged from more than 10 percent to less than 1 percent for the arterial switch operation, and from more than 35.
187 274 375 750 501 1565 139 656 226 55 559 1135 1370 465 1038 1113 856 1192 965 527 1231 321 317 561 781 1023 1224 1361 782 749 1112 744 301