Serial echocardiography for decision making in rapid two-stage arterial switch operation

Iyer, Krishna Subramony; Sharma, Rajesh; Kumar, Kiran; Bhan, Anil; Kothari, Shyam Sunder; Saxena, Anitá; Venugopal, Panangipalli

doi:10.1016/0003-4975(95)00373-s

Cited by 35 publications

(39 citation statements)

References 14 publications

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“…Echocardiography has emerged as an important tool for assessment of LV preparation 8,9 . LV mass index, LV posterior wall thickness, LV end- diastolic internal diameter, LV cavity shape, interventricular septal thickness and movement in coordination with either of ventricles were recognized as criteria that aid in the assessment 8,9 . However rapid two stage ASO has several issues that remain unclear and confound the overall outcome like size of shunt, tightness of band, defining preparedness, interval, morbidity and mortality, prolonged ICU stay leading to nosocomial infections and hospital costs.…”

Section: Discussionmentioning

confidence: 98%

“…Many centers have tried the rapid two stage ASO protocol for such late referrals with variable success 7,8 . Echocardiography has emerged as an important tool for assessment of LV preparation 8,9 . LV mass index, LV posterior wall thickness, LV end- diastolic internal diameter, LV cavity shape, interventricular septal thickness and movement in coordination with either of ventricles were recognized as criteria that aid in the assessment 8,9 .…”

Section: Discussionmentioning

confidence: 99%

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D-Transposition of great vessels with intact ventricular septum presenting at 3–8 weeks: Should all go for rapid two stage arterial switch or primary arterial switch?

Bisoi

Chauhan

Khanzode

et al. 2006

Indian J Thorac Cardiovasc Surg

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Background: Current reports favour primary arterial switch (ASO) in infants with d-transposition of great vessels (d-TGA) with intact ventricular septum (IVS) who present later than 21 days. The premise is that the regressed left ventricle (LV) will still adapt to the systemic circulation.Methods: We compared a retrospective group of 11 infants (group A) who had undergone rapid two stage ASO with those (group B) who had undergone primary ASO (n=15).Results: The age range (25 -70 days), weight (2.5 -4.0 Kg), posterior wall thickness of LV (2.8 mm -4.2 mm) and other pre-operative criteria were similar in both groups. In group A, 3/11 infants died after first stage, one each due to shunt blockade, tight pulmonary artery band, and after emergency Senning operation following cardiac failure. Of the remaining eight who underwent ASO 5 -9 days after first stage, three died, one each due to fungal infection, sepsis and multi-organ failure, and massive haemorrhage from internal mammary artery. Success of LV training was 8/11 (73%) while overall survival was 5/11 (45%). In group B (15 infants), 13 survived (86%), two needing post-operative extracorporeal membrane oxygenator (ECMO) support and two deaths occurred due to immediate post-operative cardiac failure.Conclusions: This study demonstrates that primary ASO can show benefit in infants of d-TGA with IVS presenting between 21 to 60 days of age as compared to rapid two stage ASO. These infants might need more support for the ventriclular function in form of prolonged inotropes and ECMO support. (Ind J Thorac Cardiovas Surg 2006; 22: 5-9)

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

D-Transposition of great vessels with intact ventricular septum presenting at 3–8 weeks: Should all go for rapid two stage arterial switch or primary arterial switch?

Bisoi

Chauhan

Khanzode

et al. 2006

Indian J Thorac Cardiovasc Surg

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“…As a natural mechanism to adapt to the high afterload of the right ventricle requiring higher force of contraction, IVS position starts shifting towards the left ventricle. Therefore, the crosssectional shape of the left ventricle changes from spherical to a D-shape and subsequently to a banana shape [16].…”

Section: Discussionmentioning

confidence: 99%

Primary arterial switch operation in children presenting late with d-transposition of great arteries and intact ventricular septum. When is it too late for a primary arterial switch operation?

Bisoi

Sharma

Chauhan

et al. 2010

European Journal of Cardio-Thoracic Surgery

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“…3 Other important echocardiographic tools for assessment of LV preparedness include LV mass index, LV posterior wall thickness, interventricular septal thickness and LV end diastolic internal diameter. 5 In our case, after confirmation of the diagnosis, LV was the subsequently examined to assess its preparedness for ASO. The two-dimensional echocardiography showed a crescent/banana-shaped LV with bulging of IVS toward LV and movement of IVS synchronous with that of RV suggesting signs of LV regression.…”

Section: Discussionmentioning

confidence: 99%

Transesophageal Echocardiography in a Case of Dextro- Transposition of Great Arteries with Regressed Left Ventricle

Kiran¹,

Narula²,

Makhija³

et al. 2014

Journal of Perioperative Echocardiography

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Patients with dextro-transposition of the great arteries (d-TGA) with an intact ventricular septum (IVS) beyond 21 days of age may develop left ventricular (LV) regression. Perioperative echocardiography-guided assessment of LV for signs of regression is crucial in decision-making for definitive corrective surgery, namely arterial switch operation (ASO), as a regressed LV may not be capable of sustaining the load of systemic circulation. We hereby present transesophageal echocardiography (TEE) findings in a child with d-TGA and regressed LV where decision to perform a primary ASO with integrated extracorporeal membrane oxygenation (ECMO)-cardiopulmonary bypass (CPB) circuit was made. Use of ECMO was planned as a standby technique in the event of LV failure. ECMO was eventually used as the LV was unable to sustain the load of systemic circulation after ASO.

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Serial echocardiography for decision making in rapid two-stage arterial switch operation

Cited by 35 publications

References 14 publications

D-Transposition of great vessels with intact ventricular septum presenting at 3–8 weeks: Should all go for rapid two stage arterial switch or primary arterial switch?

D-Transposition of great vessels with intact ventricular septum presenting at 3–8 weeks: Should all go for rapid two stage arterial switch or primary arterial switch?

Primary arterial switch operation in children presenting late with d-transposition of great arteries and intact ventricular septum. When is it too late for a primary arterial switch operation?

Transesophageal Echocardiography in a Case of Dextro- Transposition of Great Arteries with Regressed Left Ventricle

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