The neoaortic root in children with transposition of the great arteries after an arterial switch operation†

Michalak, Krzysztof W.; Moll, Jadwiga; Moll, Maciej; Dryżek, Paweł; Moszura, Tomasz; Kopala, Marek; Młudzik, Katarzyna; Moll, J

doi:10.1093/ejcts/ezs709

Cited by 19 publications

(16 citation statements)

References 17 publications

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“…Older age at time of ASO, presence of VSD, bicuspid pulmonic valve, previous PA banding, perioperative mild AR and higher neo-aortic root/ascending aorta ratio are risk factors for AR [98–100]. Neo-aortic root dilation is also a consequence of ASO [101, 102], especially if there is size discrepancy of the great arteries [103]. Fortunately, aortic root dilation has not been significantly progressive during the current duration of follow-up and has not been associated with acute aortic dissection or increased mortality [104].…”

Section: Life-long Follow-up Carementioning

confidence: 99%

D-Transposition of the Great Arteries

Villafañe

Lantin‐Hermoso

Bhatt

et al. 2014

Journal of the American College of Cardiology

246

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Objectives This paper aims to update clinicians on “Hot Topics” in the management of patients with d-transposition of the great arteries (D-TGA) in the current surgical era. Background The arterial switch operation (ASO) has replaced atrial switch procedures for D-TGA and 90% of patients now reach adulthood. Methods The Adult Congenital and Pediatric Cardiology Council (ACPC) of the American College of Cardiology assembled a team of experts to summarize current knowledge on genetics, prenatal diagnosis, surgical timing, balloon atrial septostomy (BAS), prostaglandin therapy (PGE), intraoperative techniques, imaging, coronary obstruction, arrhythmias, sudden death, aortic dilation and regurgitation (AR), neurodevelopmental (ND) issues and lifelong care of D-TGA patients. Results In simple D-TGA, 1) familial recurrence risk is low; 2) children diagnosed prenatally have improved cognitive skills compared with those diagnosed postnatally; 3) echocardiography helps to identify risk factors; 4) routine use of BAS and PGE may not be beneficial in some cases; 5) early ASO improves outcomes and reduces costs with a low mortality. Single or intramural coronary arteries remain risk factors; 6) post-ASO arrhythmias and cardiac dysfunction should raise suspicion of coronary insufficiency; 7) coronary insufficiency and arrhythmias are rare but associated with sudden death; 8) early and late-onset ND abnormalities are common; 9) AR and aortic root dilation are well tolerated; and 10) the aging ASO patient may benefit from “exercise-prescription” rather than restriction. Conclusions Significant strides have been made in understanding risk factors for cardiac, ND and other important clinical outcomes after ASO.

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Section: Life-long Follow-up Carementioning

confidence: 99%

D-Transposition of the Great Arteries

Villafañe

Lantin‐Hermoso

Bhatt

et al. 2014

Journal of the American College of Cardiology

246

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“…Neoaortic regurgitation (NeoAR) is a common sequela affecting patients with the transposition of the great arteries (TGA) after an arterial switch operation (ASO) [1]. In most cases, NeoAR usually does not constitute a significant clinical problem, but some patients still require reoperation because the insufficiency tends to progress [2,3]. The reason for the common occurrence of neoaortic valve (NeoAoV) incompetence is multifactorial.…”

Section: Introductionmentioning

confidence: 99%

Neoaortic Regurgitation in Patients with Transposition Long Term After an Arterial Switch Operation and Its Relation to the Root Diameters and Surgical Technique Used

et al. 2019

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Neoaortic regurgitation and root dilatation are common findings in patients with transposition after an arterial switch operation. The aim of this study was to describe the relation between neoaortic regurgitation long term after an arterial switch procedure, aortic root diameters, and surgical technique used. We also assessed the agreement of the neoaortic regurgitation grade and root diameters in different imaging modalities. For this retrospective study, we qualified 56 consecutive patients who, according to our institutional protocol, had a routine postoperative evaluation of more than 16 years with multimodality imaging studies. Neoaortic regurgitation was assessed by both transthoracic echocardiography and magnetic resonance imaging, and the root diameters obtained by echocardiography and tomography were compared to the reference values and associated with the presence of neoaortic insufficiency. Neoaortic insufficiency was present in 75% of examined patients; the vast majority of them had trace or mild regurgitation, and its qualitative evaluation was significantly different between echocardiography and magnetic resonance imaging. In our study group, the neoaortic valve and aortic sinus were larger in relation to the normal values, and they were significantly correlated with the presence of neoaortic insufficiency, but not with the surgical technique used. Values obtained by echocardiography and tomography correlated well but were significantly different. Transthoracic echocardiography has a tendency to overestimate the severity of regurgitation compared to magnetic resonance imaging. Neoaortic valve and sinus dilatation are significantly correlated with valve insufficiency, but in most cases of root dilatation, the valve remains competent.

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“…35 Hourihan et al also observed that the NAoR and PV annulus are already larger than in normal infants before the ASO. 8 An increased risk of NAoR dilation in TBA and TGA with VSD has previously been recognized, 13,16,18 highlighting the role of a significant VSD in the pathophysiology of NAoR dilatation. This is clinically relevant as the reintervention rate is higher in TGA patients with a VSD compared with those with an IVS.…”

Section: Neo-aortic Rootmentioning

confidence: 94%

“…The growth of the anastomoses of the great arteries and the competence of the native pulmonary valve (PV) and root, now functioning as the neo-aortic valve and root (NAoR), in the systemic circulation are important in the long term. [6][7][8] NAoR dilatation has been reported, [8][9][10][11][12][13][14][15][16][17] even in the first year post-ASO, [9][10][11] and the root continues to grow excessively, [15][16][17] at a rate >4 times normal. 9 The resulting aortic valve (AoV) regurgitation and aneurysm formation may require a reintervention.…”

Section: Introductionmentioning

confidence: 99%

“…Prior pulmonary artery banding, presence of a ventricular septal defect (VSD), TBA, gender, the technique used for the transfer of the coronary buttons, and the length of follow-up have been implicated. [11][12][13][14][15][16][17][18][19][20] The study aim was to document the natural growth of the semilunar valves in fetuses with TGA and to compare it with normal semilunar valve growth. We also wished to determine if NAoR dilatation post-ASO is related to the prenatal semilunar valve growth.…”

Section: Introductionmentioning

confidence: 99%

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Transposition of the great arteries: Fetal pulmonary valve growth and postoperative neo‐aortic root dilatation

et al. 2019

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ObjectivesDocumentation of semilunar valve growth in fetal transposition of the great arteries (TGA) and the relationship between neo‐aortic root (NAoR) dilatation, a cause for postoperative reinterventions after the arterial switch operation (ASO), and pulmonary valve (PV) annulus dimensions prenatally.MethodsThis retrospective multicenter observational study included TGA fetuses suitable for ASO. Semilunar valve annuli pre‐ASO and NAoR diameters (post‐ASO) were measured. Trends in annulus diameters were analyzed using a linear mixed‐effects model and compared with normal values. Prenatal semilunar valve Z‐scores were correlated with NAoR diameters post‐ASO.ResultsWe included 137 TGA fetuses (35.8% with significant ventricular septal defects [VSDs]). One hundred twenty‐one underwent ASO. Fetal TGA‐PV diameters were significantly larger than control aortic valve (AoV) and PV annuli from 23 and 27 weeks, respectively, especially when a VSD was present. Fetal TGA‐AoV annuli were significantly larger than control AoV and PV annuli from 26 and 30 weeks, respectively. Z‐scores of fetal TGA‐PV and NAoR diameter at last follow‐up correlated significantly (P < .001 at 26‐30 wk).ConclusionFetal TGA semilunar valve annuli are larger than control annuli, especially when there is a significant VSD. Factors besides postoperative hemodynamics, including fetal anatomy, PV Z‐score, prenatal flow, connective tissue properties, and genetics, may influence the risk for late reintervention in these fetuses.

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The neoaortic root in children with transposition of the great arteries after an arterial switch operation†

Abstract: The neoaortic root in children after the arterial switch procedure develops differently from that in healthy children, but this is not evidently related to NeoAR development or associated heart defects.

Cited by 19 publications

References 17 publications

D-Transposition of the Great Arteries

D-Transposition of the Great Arteries

Neoaortic Regurgitation in Patients with Transposition Long Term After an Arterial Switch Operation and Its Relation to the Root Diameters and Surgical Technique Used

Transposition of the great arteries: Fetal pulmonary valve growth and postoperative neo‐aortic root dilatation

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