Modified blalock-taussig shunt and levosimendan for left ventricular preparation in a child with transposition of great arteries and regressed ventricle undergoing rapid 2 stage arterial switch operation

Abstract

Rapid two-stage arterial switch operation (ASO) is very relevant as many patients of transposition of great arteries (TGA) present late to the hospital when primary switch either is not possible or carries a high risk of morbidity and mortality. Hence, other means apart from the traditional methods of left ventricle preparedness should be tried to help this category of patients, who are to undergo rapid two-stage ASO. We successfully used levosimendan and continuous positive airway pressure after 1st stage operation in a patient with dTGA and regressed ventricle, which helped in left ventricular preparedness, and the child underwent rapid two-stage ASO uneventfully.

A better approach for left ventricular training in transposition of the great arteries and intact interventricular septum: Bidirectional cavopulmonary anastomosis and pulmonary artery banding

“…More creative solutions such as PDA recanalization/stenting . administration of levosimendan and continuous positive airway pressure, adaptable PAB systems, different PAB strategies applied in animal models (ie, permanent, progressive or intermittent) along with the availability of mechanical circulatory support extended the limits of ASO in patients with TGA‐IVS beyond the neonatal period even up to 9 months of age …”

“…1 Surgical outcomes of the arterial switch operation (ASO) within first 4 weeks of life is encouraging; however, the clinical situation becomes more troublesome beyond this period. 2 The atrial switch procedures were the principal form of management for late presentations of patients with TGA for decades. 3 In fact, the atrial switch procedures, namely the Senning and Mustard operations convert TGA to a situation similar to congenitally corrected transposition of the great arteries (cc-TGA) where the right ventricle and the tricuspid valve serve for the systemic ventricle and atrioventricular valve, respectively.…”

“…D‐looped transposition of the great arteries (TGA) accounts for 5%‐7% of congenital heart defects . Surgical outcomes of the arterial switch operation (ASO) within first 4 weeks of life is encouraging; however, the clinical situation becomes more troublesome beyond this period . The atrial switch procedures were the principal form of management for late presentations of patients with TGA for decades .…”