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Left ventricle is better suited as pulmonary ventricle in simple transposition with severe pulmonary hypertension.
Ann Thorac Surg 2002; 74(5):1612-5AT

Abstract

BACKGROUND

The conventional treatment of transposition of great arteries with prepared left ventricle is an arterial switch operation. This, in our experience, does not hold for patients with transposition of great arteries with intact ventricular septum where the left ventricle continues to be prepared secondary to severe pulmonary arterial hypertension without an immediately reversible cause.

METHODS

Ten infants with D-transposition of the great arteries with essentially intact interventricular septum and severe pulmonary arterial hypertension underwent surgical treatment. Age ranged from 3 to 6 months (mean, 4.2 months). One of these patients had a large ductus with left to right shunting but the others had no intra- or extracardiac shunt to account for their pulmonary hypertension. All 10 had "prepared" left ventricles. The first 4 children underwent an arterial switch operation. Uneventful surgery was followed by prolonged ventilator dependence in all 4 with occurrence of severe pulmonary arterial hypertension every time weaning from ventilator was attempted. This was accompanied by metabolic acidosis and features of right heart failure. Only 1 patient with large ductus could be extubated and discharged from hospital. Subsequently, the other 6 infants underwent a Senning repair.

RESULTS

There was no early mortality. All patients were separated from mechanical ventilation within 48 hours of surgery without blood gas derangement or heart failure despite elevated pulmonary artery pressure in all. The child with the arterial switch operation has pulmonary artery pressure of 50% systemic 4 years following repair; although among the Senning group, 2 patients continue to have pulmonary artery pressure more than 60% of systemic and 4 have normal pulmonary artery pressure at a mean follow-up of 1 year.

CONCLUSIONS

Atrial level repairs seem to perform better than arterial level repairs in children having TGA with persistent pulmonary artery hypertension without a correctable cause. Better tolerance of pulmonary arterial hypertension in this group is probably consequent to the superior ability of the left ventricle to tolerate a pressure load in the early postoperative period.

Authors+Show Affiliations

Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi. rsharmacv@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

12440617

Citation

Sharma, Rajesh, et al. "Left Ventricle Is Better Suited as Pulmonary Ventricle in Simple Transposition With Severe Pulmonary Hypertension." The Annals of Thoracic Surgery, vol. 74, no. 5, 2002, pp. 1612-5.
Sharma R, Choudhary SK, Bhan A, et al. Left ventricle is better suited as pulmonary ventricle in simple transposition with severe pulmonary hypertension. Ann Thorac Surg. 2002;74(5):1612-5.
Sharma, R., Choudhary, S. K., Bhan, A., Juneja, R., Kothari, S. S., Saxena, A., & Venugopal, P. (2002). Left ventricle is better suited as pulmonary ventricle in simple transposition with severe pulmonary hypertension. The Annals of Thoracic Surgery, 74(5), pp. 1612-5.
Sharma R, et al. Left Ventricle Is Better Suited as Pulmonary Ventricle in Simple Transposition With Severe Pulmonary Hypertension. Ann Thorac Surg. 2002;74(5):1612-5. PubMed PMID: 12440617.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Left ventricle is better suited as pulmonary ventricle in simple transposition with severe pulmonary hypertension. AU - Sharma,Rajesh, AU - Choudhary,Shiv Kumar, AU - Bhan,Anil, AU - Juneja,Rajnish, AU - Kothari,Shyam Sunder, AU - Saxena,Anita, AU - Venugopal,Panangipalli, PY - 2002/11/21/pubmed PY - 2002/12/5/medline PY - 2002/11/21/entrez SP - 1612 EP - 5 JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. VL - 74 IS - 5 N2 - BACKGROUND: The conventional treatment of transposition of great arteries with prepared left ventricle is an arterial switch operation. This, in our experience, does not hold for patients with transposition of great arteries with intact ventricular septum where the left ventricle continues to be prepared secondary to severe pulmonary arterial hypertension without an immediately reversible cause. METHODS: Ten infants with D-transposition of the great arteries with essentially intact interventricular septum and severe pulmonary arterial hypertension underwent surgical treatment. Age ranged from 3 to 6 months (mean, 4.2 months). One of these patients had a large ductus with left to right shunting but the others had no intra- or extracardiac shunt to account for their pulmonary hypertension. All 10 had "prepared" left ventricles. The first 4 children underwent an arterial switch operation. Uneventful surgery was followed by prolonged ventilator dependence in all 4 with occurrence of severe pulmonary arterial hypertension every time weaning from ventilator was attempted. This was accompanied by metabolic acidosis and features of right heart failure. Only 1 patient with large ductus could be extubated and discharged from hospital. Subsequently, the other 6 infants underwent a Senning repair. RESULTS: There was no early mortality. All patients were separated from mechanical ventilation within 48 hours of surgery without blood gas derangement or heart failure despite elevated pulmonary artery pressure in all. The child with the arterial switch operation has pulmonary artery pressure of 50% systemic 4 years following repair; although among the Senning group, 2 patients continue to have pulmonary artery pressure more than 60% of systemic and 4 have normal pulmonary artery pressure at a mean follow-up of 1 year. CONCLUSIONS: Atrial level repairs seem to perform better than arterial level repairs in children having TGA with persistent pulmonary artery hypertension without a correctable cause. Better tolerance of pulmonary arterial hypertension in this group is probably consequent to the superior ability of the left ventricle to tolerate a pressure load in the early postoperative period. SN - 0003-4975 UR - https://www.unboundmedicine.com/medline/citation/12440617/Left_ventricle_is_better_suited_as_pulmonary_ventricle_in_simple_transposition_with_severe_pulmonary_hypertension_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(02)03880-8 DB - PRIME DP - Unbound Medicine ER -