Clin Res Cardiol 100, Suppl 1, April 2011

V1502 - What Happens To The Pulmonary Artery That We Meticulously Switched?
E. M. Delmo Walter1, C. Stamm1, M. Hübler1, V. Alexi-Meskishvili1, R. Hetzer1
1Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin;
Objective: We analyzed the fate of the pulmonary artery (PA) and its valve over time, after arterial switch operation (ASO) in neonates with simple and complex transposition of great arteries (TGA).
Methods: ASO using Lecompte maneuver was performed in 222 neonates (mean age 1.7 ± 0.42 days) with TGA with intact ventricular septum (IVS) and in 150 neonates (mean age 3.62 ± 0.52 days) with TGA with ventricular septal defect (VSD). Complete medical records with serial echocardiograms were reviewed for any occurrence of postoperative pulmonary stenosis and insufficiency.
Results: TGA-IVS: During a mean follow-up of 14.4 ± 0.54 years, 17.8% children developed significant pulmonary stenosis (PS) after ASO. Serial echocardiograms showed that at 1 month postoperatively pressure gradients in the range of 16-23 mm Hg occurred. Onset of significant PS occurred as early as 30 days and as late as 10 years after ASO. Freedom from intervention was 68.6±8.7% at 1 year and 42.8.1±9.5% at 5, 10 and 15 years. TGA-VSD: Among 150 patients post-ASO, 10% developed significant PS and 4.6% significant pulmonary valve insufficiency during a mean follow-up period of 12.53±0.78 years. Mean pressure gradients of 15 mmHg first occurred 2 months after ASO and became progressive, warranting intervention. The latest occurrence of PS was seen 9 years postoperatively. Freedom from intervention was 72.4±9.6% at 1 year and 53.11±10.9% at 5, 10 and 15 years. Multivariate analysis showed that the only significant risk factor contributing to the fate of the PA after ASO is the use of two-patch technique for PA reconstruction.
Conclusions: After ASO, pulmonary arteries may become stenotic at the valve, trunk, bifurcation or branch level, and/or the valve may become insufficient over a period of time.
Clin Res Cardiol 100, Suppl 1, April 2011
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-011-1100-y