Outcome of patients with double-inlet left ventricle or tricuspid atresia with transposed great arteries

Abstract

The mortality of patients with DILV or TA-TGA remains high. The outcomes of these patients are influenced by restriction of pulmonary blood flow, arrhythmia, and pacemaker requirement. Surgical palliation to relieve systemic outflow obstruction is not associated with a poor outcome.

Outcome of the Norwood procedure in the setting of transposition of the great arteries and functional single left ventricle☆

“…In a recent study by the same group, Lan et al suggested that systemic obstruction associated with a gradient but without ventricular hypertrophy, does not influence longterm outcome [8].…”

“…This strategy requires close observation of the subaortic and aortic area and an early DKS procedure should obstruction develop [4][5][6][7][8]. Using a vigorous surveillance to detect subaortic obstruction, Odim et al were able to recognise early development of subaortic obstruction in 8 of 15 patients following pulmonary artery band [5].…”

“…Furthermore, in cases of obstruction due to abnormal attachments of the atrioventricular valve, VSD enlargement may not be effective [14]. Despite the constant course of the conduction axis in hearts with usual atrial arrangements and a dominant left ventricle [1], postoperative heart block occurs in 8-34% patients post procedure [8,19]. Lan et al, in a large series of patients with diagnosis of TGA and DILV or TA, reported their long-term results with different surgical strategies [8].…”

“…Patients without any evidence of subaortic obstruction can be simply managed with a pulmonary artery (PA) band with or without arch repair as required [4][5][6][7][8]. However, even with the arch repaired, the risk of a PA band alone in these patients is the progressive development of subaortic obstruction in the future with an unpredictable time course [9][10][11][12].…”

“…Enlargement of the VSD through the aortic valve has been suggested, but this can be technically difficult and postoperative heart block due to damage of the conduction system is a significant complication [8,13,14].…”