Transposition of the great arteries: single center experiences

Year 2022, Volume: 16 Issue: 3, 172 - 178, 20.12.2022

Başak Soran Türkcan , Mustafa Yılmaz , Yasemin Özdemir Şahan , Ömer Ertekin , Ata Niyazi Ecevit , Atakan Atalay

Abstract

Objectives: Transposition of great arteries is the most common cyanotic congenital heart disease. It is characterized by ventriculoarterial discordance and atrioventricular concordance. The aim of the present study was to review the anatomical and embryological basis of this anomaly and to discuss the surgical outcomes of arterial switch operations.
Methods: The study included a total of 61 patients who underwent arterial switch operation. Demographic, anatomical, operative data, duration of stay in intensive care unit, need of postoperative extra corporeal membrane oxigenator, need of delayed sternal closure and mortality rate were retrieved from the institutional databases and medical records.
Results: The median age of the patients was 22.9±61.26 (1–455) days, and their weights ranged between 3391.97±686.6 (1900–5500) grams. Transposition of great arteries accompanied intact ventricular septum in 39 patients (63.9%) and ventricular septal defect in 22 patients (36.1%). Coronary arteries were abnormal in 11 patients (18%). Mortality was observed in 7 patients (11.5%) and was seen 5.71±2.98 (1–10) days after surgery. The incidence of coronary anomaly in patients with mortality was 28.6%. The most common coronary anomaly in patients with coronary anomaly with mortality is the anomaly in which the circumflex artery originates from the right coronary artery.
Conclusion: Arterial switch operations provide anatomical and complete correction in transposition of great arteries. It can be performed with appropriate timing, good preoperative, peroperative and postoperative management with low mortality. Coronary artery anomaly is not a contraindication for arterial switch operations, and with the detailed and careful evaluation of the appropriate coronary artery anatomy, transpositions with coronary anomalies are often uneventful.

Keywords

arterial switch operation, Jatene operation, Lecompte maneuver, transposition of great arteries

References

• Marek J, Tomek V, Skovránek J, Povysilová V, Samánek M. Prenatal ultrasound screening of congenital heart disease in an unselected national population: a 21-year experience. Heart 2011;97:124–30.
• Fricke TA, d’Udekem Y, Richardson M, Thuys C, Dronavalli M, Ramsay JM, Wheaton G, Grigg LE, Brizard CP, Konstantinov IE. Outcomes of the arterial switch operation for transposition of the great arteries: 25 years of experience. Ann Thorac Surg 2012;94: 139–45.
• Kempny A, Wustmann K, Borgia F, Dimopoulos K, Uebing A, Li W, Chen SS, Piorkowski A, Radley-Smith R, Yacoub MH, Gatzoulis MA, Shore DF, Swan L, Diller GP. Outcome in adult patients after arterial switch operation for transposition of the great arteries. Int J Cardiol 2013;167:2588–93.
• Oda S, Nakano T, Sugiura J, Fusazaki N, Ishikawa S, Kado H. Twenty-eight years’ experience of arterial switch operation for transposition of the great arteries in a single institution. Eur J Cardiothorac Surg 2012;42:674–9.
• Shaner RF. Anomalies of the heart bulbus. J Pediatr 1962;61:233–41.
• Grant RP. The morphogenesis of transposition of the great vessels. Circulation 1962;26:819–40.
• Grant RP. The embryology of ventricular flow pathways in man. Circulation 1962;25:756–79.
• Martins P, Castela E. Transposition of the great arteries. Orphanet J Rare Dis 2008;3:27.
• Samánek M, Slavík Z, Zborilová B, Hrobonová V, Vorísková M, Skovránek J. Prevalence, treatment, and outcome of heart disease in live-born children: a prospective analysis of 91,823 live-born children. Pediatr Cardiol 1989;10:205–11.
• Güçer S, Ince T, Kale G, Akçören Z, Ozkutlu S, Talim B, Cağlar M. Noncardiac malformations in congenital heart disease: a retrospective analysis of 305 pediatric autopsies. Turk J Pediatr 2005;47:159–66.
• Ho SY, Baker EJ, Rigby ML, Anderson RH. Color atlas of congenital heart disease - morphologic and clinical correlations. London: Mosby-Year Book; 1995. 192 p.
• Ashworth M, Al Adnani M, Sebire NJ. Neonatal death due to transposition in association with premature closure of the oval foramen. Cardiol Young 2006;16:586–9.
• Jatene AD, Fontes VF, Paulista PP, Souza LC, Neger F, Galantier M, Sousa JE. Anatomic correction of transposition of the great vessels. J Thorac Cardiovasc Surg 1976;72:364–70.
• Loffredo CA, Silbergeld EK, Ferencz C, Zhang J. Association of transposition of the great arteries in infants with maternal exposures to herbicides and rodenticides. Am J Epidemiol 2001;153:529–36.
• Qureshi AM, Justino H, Heinle JS. Transposition of the great arteries. In: Shaddy RE, Penny DJ, Feltes TF, Cetta F, Mital S, editors. Moss and Adams’ heart disease in infants, children and adolescents, including fetus and young adult. 10th ed. Philadelphia (PA): Wolters Kluwer; 2022. p. 3336–57.
• Tálosi G, Katona M, Rácz K, Kertész E, Onozó B, Túri S. Prostaglandin E1 treatment in patent ductus arteriosus dependent congenital heart defects. J Perinat Med 2004;32:368–74.
• Hörer J, Herrmann F, Schreiber C, Cleuziou J, Prodan Z, Vogt M, Holper K, Lange R. How well are patients doing up to 30 years after a mustard operation? Thorac Cardiovasc Surg 2007;55:359–64.
• Hörer J, Karl E, Theodoratou G, Schreiber C, Cleuziou J, Prodan Z, Vogt M, Lange R. Incidence and results of reoperations following the Senning operation: 27 years of follow-up in 314 patients at a single center. Eur J Cardiothorac Surg 2008;33:1061–7.
• Mavroudis C, Backer CL. Transposition of the great arteries. In: Mavroudis C, Backer CL, editors. Pediatric cardiac surgery. 4th ed. Oxford, UK: Wiley-Blackwell; 2013. p. 492–529.
• Yacoub MH, Radley-Smith R, Maclaurin R. Two-stage operation for anatomical correction of transposition of the great arteries with intact interventricular septum. Lancet 1977;1:1275–8.
• Kınoğlu B, Sarıoğlu T, Çalık MK, Sarıoğlu A, Tekin S, Turan T, Olga R. Two stage arterial switch for transposition of the great arteries. Turkish Journal of Thoracic and Cardiovascular Surgery 1997;5:11–18.
• Kalko Y, Hökenek F, Sever K, Söyler İ, Tireli E, Dayıoğlu E, Onursal E, Dindar A. The early results of arterial switch operations for transposition of the great arteries. Turkish Journal of Thoracic and Cardiovascular Surgery 2001;9:35–8.
• VanMierop LH, Alley RD, Kausel HW, Stranahan A. Pathogenesis of transposition complexes. I. Embryology of the ventricles and great arteries. Am J Cardiol 1963;12:216–25.
• Lecompte Y. Réparation à l’Etage ventriculaire - the REV procedure: technique and clinical results. Cardiol Young 1991;1:63–70.
• Warnes CA. Transposition of the great arteries. Circulation 2006;114:2699–709.