20 years of arterial switch operation for simple TGA

Is the Lecompte technique the last word on transposition of the great arteries repair for all patients? A magnetic resonance imaging study including a spiral technique two decades postoperatively

“…The patients in our cohort showed overall larger aortic root dimensions compared with controls. The riding of the pulmonary artery over the ascending aorta after Lecompte procedure frequently results in flow acceleration or stenosis of the pulmonary artery and its branches that may lead to a reoperation and/or right ventricular dysfunction [6,9,23]; and the dynamic characteristic of this stenosis was shown by Gutberlet et al [24]. Taken together, our 4D flow measurements yielded more physiological blood flow profiles in patients who underwent spiral anastomoses.…”

“…Since then, short-term surgical results have been reported to be excellent with low mortality [5]. Long-term followup data revealed also excellent clinical results in the majority of patients but showed some rare drawbacks, including pulmonary stenosis [6], dilatation of ascending aorta [7], diastolic dysfunction [8], aortic stiffening [9] and even progressive aortic regurgitation [10], the latter potentially due to the steeply angled aortic arch after ASO [11]. These adverse long-term outcomes have prompted the evaluation of alternative surgical techniques [11,12].…”

A Quarter-Century After Primary Direct Arterial Switch Operation: Four-D-Flow MRI Video Imaging of Blood Flow Dynamics Outcomes

“…Early results were excellent, but late problems occurred in some patients calling for alternative techniques. [5][6][7][8][9][10] Somatic growth is one of the crucial tests for quality assessment in pediatric cardiac surgery. As far as we know, we present for the first time a video of blood flow streamlines derived from 4-D-flow MRI in a case of simple TGA 25 years after direct spiral anatomic correction (DSAC).…”

“…Early results were excellent, but late problems occurred in some patients calling for alternative techniques. 5 –10…”

Advances in the diagnostics and management of congenital heart diseases

“…The remaining RV body is connected to the pulmonary artery with an extracardiac conduit. From the 1990s, the above procedures have been replaced by the neonatal arterial switch surgery, when the two great arteries (aorta and pulmonary artery) are transected and interchanged, then the pulmonary arteries are sutured to the RV and the aorta to the LV, and the coronary arteries are replaced to the pulmonary artery supplying the systemic circulation (32). cases.…”