Clinical features and surgical outcomes of complete transposition of the great arteries

Abstract

PurposeThis single-center study aimed to assess the clinical features and surgical approaches and outcomes of complete transposition of the great arteries (TGA).MethodsTGA patients who had undergone surgical correction at the Kyungpook National University Hospital from January 2000 to December 2010, were retrospectively evaluated for patient characteristics, clinical manifestation, preoperative management, intraoperative findings, postoperative progress, and follow-up status.ResultsTwenty-eight patients (17 boys and 11 girls, mean age=10.6±21.5 days) were included and were categorized as follows: group I, TGA with intact ventricular septum (n=13); group II, TGA with ventricular septal defect (VSD, n=12); and group III, TGA/VSD with pulmonary stenosis (n=3). Group I underwent the most intensive preoperative management (balloon atrial septostomy and prostaglandin E1 medication). Group II showed the highest incidence of heart failure (P<0.05). Usual and unusual coronary anatomy patterns were observed in 20 (71%) and 8 patients, respectively. Arterial and half-turned truncal switch operations were performed in 25 and 3 patients (Group III), respectively. Postoperative complications included cardiac arrhythmias (8 patients), central nervous system complications (3 patients), acute renal failure (1 patient), infections (3 patients), and cardiac tamponade (1 patient), and no statistically significant difference was observed between the groups. Group II showed the mildest aortic regurgitation on follow-up echocardiograms (P<0.05). One patient underwent reoperation, and 1 died. The overall mortality rate was 4%.ConclusionOur study showed favorable results in all the groups and no significant difference in postoperative complication, reoperation, and mortality among the groups. However, our results were inadequate to evaluate the risk factors for reoperation and mortality owing to the small number of patients and short follow-up duration.

Systematic Literature Review on the Incidence and Prevalence of Heart Failure in Children and Adolescents

“…Three retrospective studies reported the incidence of HF in pediatric patients diagnosed with congenital heart disease [ 24 – 26 ]. A Canadian study reported a HF incidence of 57.9% among 19 infants with Scimitar Syndrome (Table 2 ) [ 25 ].…”

“…In a Jamaican study, HF developed in 23.9% of 46 patients with trisomy 21 and congenital heart disease and/or cardiac lesions [ 26 ]. A study from South Korea reported that, overall, HF developed in 17.9% of 28 patients presenting with transposition of the great arteries (TGA), and the rate was 41.7% in patients who also had ventricular septal defects (VSDs) (Table 2 ) [ 24 ].…”

No difference found in safety or efficacy of balloon atrial septostomy performed at the bedside versus the catheterisation laboratory

“…Bedside balloon atrial septostomy has the advantages of decreased patient transport, reduced radiation exposure, and decreased resource utilisation and cost compared with atrial septostomy performed in the catheterisation laboratory. Although septostomy in the cardiac catheterisation laboratory has the advantage of characterising coronary anatomy, some studies suggest 19 that coronary anomalies are not a significant risk factor in the arterial switch operation. In the current era of a focus on quality improvement, while encouraging cost containment, we advocate that bedside balloon atrial septostomy offers equivalent safety and clinical outcome with the benefit of considerable cost savings compared with the catheterisation laboratory.…”

Đánh Giá Kết Quả Phẫu Thuật Sửa Toàn Bộ Bệnh Chuyển Vị Đại Động Mạch (Tga) Tại Bệnh Viên Tim Hà Nội

“…Như vậy, tỉ lệ sống sót sau phẫu thuật chiếm 92% (23/25). Kết quả của chúng tôi tương tự của các nghiên cứu khác trên trên thế giới có tỷ lệ tử vong sớm từ 2,9% đến 11,4% [3], [1], [5].…”