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TGA-IVS and TGA-VSD Seen Late

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Surgery of Conotruncal Anomalies

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Abstract

Late referral of patients with complete transposition of the great arteries (TGA) is common in developing countries. However, outcomes of these patients who undergo surgical correction late remain unclear. To obtain favorable outcomes in these “late” patients, understanding of the surgical indications, management and specific surgical techniques is essential. Although the anatomical and hemodynamic features of ‘TGA- intact ventricular septum (IVS)’ and ‘TGA-ventricular septal defect (VSD)’ seen late are different, arterial switch operation (ASO) generally remains the prevailing surgical procedure for both of them. According to the pathophysiological changes, we define ‘TGA-IVS seen late’ as refer to therapy beyond the age at 1 month and ‘TGA-VSD seen late’ as refer to therapy beyond the age at 6 months.

In TGA-IVS seen late, favorable left ventricular (LV) geometry is the prerequisite. Age, LV shape, pressure ratio between the two ventricles and LV mass index are the determinants for primary or two-stage ASO. In general, overall outcomes of ASO undertaken for TGA-IVS seen late are favorable. Two-stage ASO is associated with higher late mortality and more neo-aortic regurgitation. Later age at retraining is associated with higher late mortality. Age beyond 3 months at retraining is associated with impaired LV function.

In TGA-VSD, pulmonary vascular obstructive disease is the main challenging feature associated with late presentation, particularly with respect to late operability and postoperative safety. Moreover, accompanying diameter mismatch between the pulmonary trunk and aorta needs surgical attention, i.e. neo-aortic sinotubular reconstruction, to minimize postoperative neo-aortic regurgitation. Outcomes are satisfactory when ASO performed before 3 years of age. In the contrary, sub-optimal outcomes, including high prevalence of pulmonary hypertension crisis and valve insufficiency, will present if the ASO performed beyond 3 years of age. Palliative ASO with a fenestration on the VSD patch has proven to provide a more safety postoperative course.

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Authors and Affiliations

  1. Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, PR China

    Shoujun Li MD & Kai Ma MD, PhD

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  1. Shoujun Li MD
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  2. Kai Ma MD, PhD
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Correspondence to Shoujun Li MD .

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Editors and Affiliations

  1. Royal Brompton Hospital, London, United Kingdom

    Francois Lacour-Gayet

  2. C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan, USA

    Edward L. Bove

  3. German Pediatric Heart Center, Asklepios Klinik Sankt Augustin Gmb, Sankt Augustin, Germany

    Viktor Hraška

  4. University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA

    Victor O. Morell

  5. Department of Cardiothoracic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Thomas L. Spray

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Li, S., Ma, K. (2016). TGA-IVS and TGA-VSD Seen Late. In: Lacour-Gayet, F., Bove, E., Hraška, V., Morell, V., Spray, T. (eds) Surgery of Conotruncal Anomalies. Springer, Cham. https://doi.org/10.1007/978-3-319-23057-3_16

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  • DOI: https://doi.org/10.1007/978-3-319-23057-3_16

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