The aso remains a major, complex cardiac operation that is performed in the first few weeks of life and requires surgeons specifically trained in such newborn repairs. Clinical recognition can be challenging, so echocardiography is often the means by which definitive diagnosis is made. The arterial switch operation, also called the jatene procedure, is an. We report successful lung transplantation in a case of pulmonary hypertension after arterial switch operation. No patients survived the earlier arterial switch methods. The eventually successful solution in the form of the now popular arterial switch operation aso was elucidated after multiple contributions. The arterial switch operation is the most common operation to correct tga as of 2016. The arterial switch operation aso has replaced atrial switch. A history of german measles rubella or another viral illness in the. Transposition of the great arteries symptoms and causes mayo. The perinatal circulation and aortopulmonary transposition. This timeline lists prominent names, accomplishments, and events in the history of newborn medicine. Sep 10, 20 outcome in adult patients after arterial switch operation for transposition of the great arteries. The human heart was considered a surgical untouchable for most part of scientific history.
Less than 2% develop complete heart block, most of whom had a ventricular septal defect in addition to the transposition. Methods and resultsa singleinstitution retrospective cohort. What are the longterm outcomes after the arterial switch operation aso for dtransposition of the great arteries dtga. There are few reports of the appearance of pulmonary arterial hypertension following arterial switch surgery in the neonatal period to correct transposition of the great arteries. These conditions are patent ductus arteriosus, secundum atrial defect, and uncomplicated ventricular septal defect. Usually, the jatene arterial switch operation is the procedure of choice. Historical evolution of surgery for transposition of great arteries.
Cto of the lad in a young adult after the arterial switch. Surgery is the mainstay of treatment for congenital heart disease, and the expected results can be classified as follows. Contemporary management and outcomes in congenitally. It was the first method of dtga repair to be attempted, but the last to be put into regular use because of technological limitations at the time of its conception. The atrial switch operation was developed by the efforts of many surgeons, with the most notable contributions made by blalock, hanlon, albert, baffes, senning, and mustard. Late complications following the arterial switch operation. The maneuver entails cutting the main pulmonary artery and moving it anterior to the aorta before reattaching the pulmonary artery during the following reconstruction of the great vessels.
Transposition of the great arteries in chapter 14 from a practical approach to cardiac anesthesia. Jan 06, 2017 this video shows the repair of a newborn with transposition of the great arteries and ventricular septal defect by means of arterial switch and vsd closure. Longterm outcomes of the neoaorta after arterial switch operation for transposition of the great arteries. Orlando regional healthcare is an approved provider of continuing nursing education by florida board of nursing provider no. The arterial switch operation 19541975 the embryo project. The incidence is estimated at 1 in 3,5005,000 live births, with a maletofemale ratio 1. Cardiopulmonary bypass outflow was established through the right subclavian and femoral arteries because of the previous arterial. Natural history of transpo sition of the great arteries.
Outcome in adult patients after arterial switch operation for. Now reflecting recent significant changes in the field, critical heart disease in infants and children, 3rd edition, keeps you abreast of the skills and knowledge required to safely care for children with congenital and acquired heart disease in the icu. Pulmonary arterial hypertension and neonatal arterial. Objectives we sought to determine cardiac outcomes in young adults with complete transposition of the great arteries tga after the arterial switch operation aso. The aorta is cannulated near the base of the innominate artery, and both the superior and inferior vena cava have been separately cannulated. The longterm survival rates for patients with dtga following surgical correction are excellent for both arterial switch operation and atrial switch procedures. We track outcomes from common procedures as quality indicators for congenital heart surgery. Therefore, from the 1960s to the 1980s, venous switch surgeries became the dominant treatment method for transposition of the great arteries. Transposition of the great arteries and the arterial. Surgical approach to anomalous left coronary artery from. Past, present, and future of the arterial switch operation. For babies with heart defects, death risk is far lower at. Neoaortic regurgitation in patients with transposition long term after an arterial switch operation and its relation to the root diameters and surgical technique used krzysztof w.
Medical treatment of transposition of the great arteries before surgery. The surgery, known as the arterial switch operation, is typically performed within a few days of birth. Transposition of the great arteries is a serious but rare heart defect. Arterial switch operation or arterial switch, is an open heart surgical procedure used to correct dextrotransposition of the great arteries dtga. Definition and epidemiology, etiology, pathophysiology, clinical features, investigations, diagnosis. The left and right coronary artery ostia are visualized and excised from the aortic root with adjacent aortic wall as buttons. Arterial switch operation or arterial switch, is an open heart surgical procedure used to correct dextrotransposition of the great arteries. This operation will require the use of cardiopulmonary bypass heartlung machine. Arterial switch, atrial switch, congenital heart disease, history of openheart surgery, transposition of great arteries. Adib jatene developed the arterial switch operation in 1975 in sao paulo, brazil. Between september 1995 and january 2014, 128 consecutive arterial switch operations were performed.
To evaluate the early and medium term results of operations for congenitally corrected transposition of the great arteries cctga wherein the left ventricle becomes the systemic ventricle. This operation, called an arterial switch operation, is done within the first few weeks of life. Ninetynine percent of the surgeries are successful. Mustard attempted his version of the arterial switch operation in 1954 on. Diagnosis involves careful history taking and physical examination of the. It is used to correct many forms of transposition of the great arteries, a congenital heart defect in which the aorta and the pulmonary artery are reversed. Arterial switch operation and ventricular septal defect repair, norwood procedure, glennhemifontan, fontan, truncus repair, complete atrioventricular canal repair, and tetralogy of fallot repair. The arterial switch operation is the standard procedure for patients with dtga without major pulmonic stenosis. Typical anatomy and cannulation for the arterial switch operation for simple transposition of the great arteries.
Clinical guidelines for the management of patients with transposition. Transposition of the great arteries statpearls ncbi. A 19yearold man had undergone the arterial switch operation with ventricular septal defect vsd repair in infancy but was lost to followup, returning to medical attention desiring clearance prior to becoming a forest ranger. Arterial switch to 12 oclock associated with reduced coronary reserve in adolescence. The arterial switch operation is appropriate treatment for most forms of transposition of the great arteries. Jacobs1 forty years ago, when adib jatene, in sao paulo, brazil performed the first successful arterial switch operation on an infant with transposition of the great ar. The only outlet from the left ventricle lv is a ventricular septal defect vsd. Transposition of the great arteries orphanet journal of. Patients with these conditions rarely have longterm sequelae after surgical correction in childhood. Van praagh r, jung wi the arterial switch operation in transposition of the great arteries. Transposition of the great arteries 25 years after. Arterial switch operation for dtga by dr attawar sandeep. Backgrounddata regarding longterm outcomes after the arterial switch operation for dtransposition of the great arteries are scarce. Arterial switch operation or arterial switch, is an open heart surgical procedure used to correct.
Pediatric cardiothoracic surgery arterial switch operation. Surgical mortality during this period was analyzed retrospectively. Double switch for congenitally corrected transposition of. Although offering excellent long term results, this procedure is burdened by the risk of acute and subacute coronary occlusion. Transposition of the great arteries is a condition where that the two main blood vessels leaving the heart, the pulmonary artery which takes blood to the lungs to pick up oxygen and the aorta which takes blood from the heart to the body are swapped over switched. Arrythmias chronotropic impairment found consistently postaso associated with residual hemodynamic lesions or cad late postoperative atrial flutter or fibrillation, is associated with rvot obstruction khairy p et al. Arterial switch to 12 oclock associated with reduced. It is performed early in life and includes switching of the aorta and coronary arteries from the systemic rv and of the pa from the lv and reattaching both great arteries to the appropriate ventricles. Supra pulmonary stenosis after arterial switch operation for transposition of the great arteries.
Arterial switch operation for dtga by dr attawar sandeep g. The experience gained in coronary artery transfer during the arterial switch operation has facilitated techniques for coronary transfer to repair the alcapa. Postoperative management of the arterial switch operation for the great arteries in chapter 18 from cardiac anesthesia. Congenitally corrected transposition of the great arteries cctga can occur in isolation, or in combination with other structural cardiac anomalies, most commonly ventricular septal defect, pulmonary stenosis and tricuspid valve disease. Double outlet right ventricle dorv, as depicted in the image below, is a type of ventriculoarterial connection in which both the aorta ao and pulmonary artery pa arise entirely or predominantly from the right ventricle rv. Arterial switch operation for tga restores the left ventricle as systemic ventricle operative mortality now book provides a comprehensive overview of exercise physiology in patients with congenital heart disease and other pediatric cardiopulmonary disorders. Arterial switch, atrial switch, congenital heart disease, history of open heart surgery, transposition of great arteries. That surgery lasted until 1998 when it was replaced with the arterial switch operation. Then, when libby was 74 days old and just over 5 pounds, dr.
Transposition of the great arteries great ormond street. The transposition of the great arteries was first described by mathew baillie in 1797, in the second edition of the book the morbid anatomy of some of the most important parts of the human body. When the infant is about one week old, an arterial switch operation is performed which corrects the defect by connecting the aorta to the left ventricle and the pulmonary artery to the right ventricle, as in a normal heart see animation at right. Fbn 2459 and the north carolina nurses association. During the aso, the surgeon will transect both the pulmonary trunk and aorta then translocate them to their anatomically correct positions. Fourteen patients with cctga who underwent anatomic repair from 1994 to 1998 were placed in one of two groups.
Each visit should include history taking, clinical examination, 12lead. In this surgical operation, the aorta and pulmonary artery are both moved to their normal position. In most patients, the anomalous left coronary artery is situated in a position that allows for direct transfer of the anomalous. Cardiac outcomes in young adult survivors of the arterial. The following data show childrens hospital of philadelphia s chop outcomes for the arterial switch operation, for the repair of transposition of the great arteries.
No guidelines exist for the management of acute or chronic ischemia in this setting. It is an openheart procedure that requires a temporary stopping of the babys heart while a heartlung machine handles respiration and blood circulation. The arterial switch operation is the procedure of choice for correction of transposition of the great arteries. Common coronary artery arrangements in dtga anatomy of the coronary arteries in tga and methods for their transfer in anatomic correction.
The small coronary arteries, which feed the heart muscle with blood, need to be transferred as well as the two great arteries aorta and pulmonary artery. Background although cardiac outcomes in the pediatric population with tga after aso have been well described, outcomes in the adult population have not to our knowledge been studied. First successful arterial switch operation for transposition of the great vessels tgv 1978. Cardiovascular outcomes after the arterial switch operation for d transposition of the great arteries. Pediatric intensivists, cardiologists, cardiac surgeons, and anesthesiologists from leading. This desk reference is organized by common procedure nomenclature used in the hospital setting, which is linked to the related root operation tables. The arterial switch operation is aimed at normalizing ventriculoarterial concordance. Following aortic cross clamping, the ascending aorta and main pulmonary artery are transected. An arterial switch operation is an openheart procedure. William mcmahon, a pediatric interventional cardiologist, successfully performed a balloon atrial septostomy, which allowed libbys oxygen levels to stabilize. The operation was the first to realign the vessels incorrect anatomical position. The society of thoracic surgeons sts congenital heart surgery database shows an expected outcome of 1. Arterial switch operation patients uncommonly develop arrhythmia, with no more than 5% experiencing difficulties.
The cost of surgical procedure for the treatment of total anomalous pulmonary venous connection repair or tapvc repair will be more than a general openheart surgery and will change according to the following. Kempny a1, wustmann k, borgia f, dimopoulos k, uebing a, li w, chen ss, piorkowski a, radleysmith r, yacoub mh, gatzoulis ma, shore df, swan l, diller gp. With this article, you will be perfectly prepared for test questions concerning the classification and management of the congenital heart disease. The brazilian cardiac surgeon, adib jatene, reported the first successful arterial switch. Mortality rates ranged from more than 10 percent to less than 1 percent for the arterial switch operation, and from more than 35. The arterial switch operation before jatene springerlink. Check out these bestsellers and special offers on books and newsletters from mayo clinic. The coronary arteries are reimplanted into the neoaorta. Arterial switch operation definition of arterial switch. The difficulty with this operation is the coronary arteries. Department of transportation in the interest of information exchange.
Highrisk patients with a history of atypical, intramural, or problematic coronary. Congenital heart disease chd classification and management. Grownup congenital heart disease guch textbook of cardiology. Permanent treatment requires a surgical procedure to switch the arteries to their proper places. Transposition of the great arteries the patient guide to. The first book on fetalmaternal and neonatal physiology. Jun 07, 2012 the arterial switch operation is a simple concept.
Program world society for pediatric and congenital heart. Outcomes of patients after arterial switch operation. The arterial switch procedure, also known as the jatene switch procedure, is an intervention designed to correct dtransposition of the great arteries dtga at the level of the aorta and main pulmonary artery. Anomalous left coronary artery from the pulmonary artery.
The objective of this paper was to describe the outcomes in patients submitted to arterial switch operation and to analyze the predictors of inhospital mortality and further need of re operation at a singlecenter institution. Aug 15, 2008 attempts at the arterial switch operation predated the senning and the mustard venous switch procedures. Our patient stories birmingham, alabama al childrens. The journal of thoracic and 672 brief communications. However, the term transposition was only applied in 1814, by farre, meaning that aorta and pulmonary trunk were placed positio across trans the ventricular septum. N2 the arterial switch operation has been the principal treatment for transposition of the great arteries and its variants for the last 25 years. Although the arterial switch is a major surgical procedure, the results are excellent. Early surgery is essential and involves the arterial switch operation, which is carried out in the first week or two of life and corrects the abnormality. The corresponding rates for 17 children with isolated taussigbing anomaly were 81% and 100%. The aorta and the pulmonary artery are transected above the valves, moved to the correct position, and sewn in place. Critical heart disease in infants and children by ross m. It is for this reason that the operation is performed in the newborn period while the left ventricle remains adequately prepared to support the systemic circulation. Covu jg, ginde s, bartz pj, frommelt pc, tweddell js, earing mg ann thorac surg 20 may.
Arterial switch operation, which is another common and effective surgical procedure, is usually most often performed during the infants early months of his or her life. Babies born with transposition of the great arteries undergo arterial switch in first days of life. Regina mcelroy director office of transportation management notice this document is disseminated under the sponsorship of the u. Transposition of the great arteries tga, arterial switch operation aso, jatene. The procedures are described in laymans terms, translated to icd10pcs root operation terminology, and the corresponding root operation tables are. The arterial switch procedure requires cardiopulmonary bypass and aortic cross clamping. Transposition of the great arteries and the arterial switch. Medical disease and differential diagnosis what is transposition of the great arteries tga. T1 late complications following the arterial switch operation. Transposition of the great arteries, dtype congenital.
Transposition of the great arteries orphanet journal of rare. The jatene procedure, or arterial switch, is an open heart surgical procedure used to correct dextrotransposition of the great arteries dtga. Cardiovascular outcomes after the arterial switch operation. The role of myocardial perfusion scintigraphy and echocardiographic wallmotion analysis in the postoperative assessment of patients after the arterialswitch operation. The longterm survival 20 years after discharge is about 95 and 80 percent for arterial switch and atrial switch respectively. Cedars 2015 primary prevention of sudden cardiac death in adults with transposition of the great arteries. Oct, 2008 transposition of the great arteries tga, also referred to as complete transposition, is a congenital cardiac malformation characterised by atrioventricular concordance and ventriculoarterial va discordance. In 50% of cases, the va discordance is an isolated finding. This chapter includes a recommendation that evaluation for disability due to congenital heart disease be divided into four age groupings consistent with the changed timing of surgery for these defects and the developmental capacities of these age groups. Cardiovascular outcomes after the arterial switch operation for d.
Surgeons reconstruct the heart so that the aorta is attached to the left ventricle and the pulmonary artery is attached to the right ventricle. Guidelines are no substitutes for textbooks, primary literature sources. Mortality is higher when there are additional defects like a hole in the heart vsd or narrowing of the arteries to the body aorta. It allows the surgeon to reconstruct the right ventricular outflow tract without needing to connect the. The lecompte maneuver is a technique used in open heart surgery, primarily on infants and children. The science and art of cardiac surgery has made rapid strides in the past 65 years. The modern repair that is preferred is called the arterial switch operation aso for short. Lung transplant for pulmonary arterial hypertension after. Transposition of the great arteries childrens hospital. Daniel t, jokhadar m, sahu a, kogon b, konno aortoventriculoplasty following arterial switch operation requires pulmonary valve disruption and right ventricular outflow tract reconstruction.