Introduction primary arterial switch operation is the procedure of choice in. Pdf longterm followup assessment after the arterial switch. Therefore, in patients with tgaivs, we prefer to perform the arterial switch operation aso ideally during the first few weeks of life when the lv is still prepared to support the systemic circulation 1. The result is that blood containing oxygen from the lungs is pumped back into the lungs, while blood that lacks oxygen. In such a situation, to avoid the risk of overstretching, we used a. T1 late complications following the arterial switch operation. Primary arterial switch operation in children presenting late with dtransposition of great arteries and intact ventricular septum. Pdf split and merge is a very simple, easy to use, free, open source utility to split and merge pdf files. Whereas coronary complications are regarded as a major risk factor for early postoperative morbidity and mortality after. Presented at the world society for pediatric and congenital heart surgery regional scientific meeting kyoto symposium. When layering images with the merge node, you need to select a compositing algorithm that determines how the pixel values from one input are calculated with the pixel values from the other to create the new pixel values that are output as the merged image. Transposition of the great arteries, arterial switch operation, coronary.
Daniel tobler adult congenital heart disease university hospital basel. Because there was insufficient power in the data to. Longterm fate of the aortic valve after an arterial switch. The arterial switch operation aso first described by jatene and colleagues in 1975 has replaced atrial switch operations as the operation of choice in north. The arterial switch operation for transposition of the. 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. The following data shows childrens hospital of philadelphia s outcomes for the arterial switch operation, for the repair of transposition of the great arteries.
Arterial switch operation for transposition of great arteries. When is it too late for a primary arterial switch operation. In 1975, adib jatene conducted the first successful arterial switch operation on a human. Arterial switch operation longterm outcomes all good. Pediatric cardiothoracic surgery arterial switch operation. Pdf the arterial switch operation aso is the preferred technique for correcting transposition of the great arteries, but translocation and. Consequences of arterial switch operation in children born with transposition of the great arteries a clinical and experimental study of the autonomous nervous system in the heart cecilia falkenberg 20 cecilia. This operation, called an arterial switch operation, is done within the first few weeks of life. In transposition of the great arteries, the two major arteries leaving the heart are connected to the wrong ventricles, the two lower chambers of the heart. Oct 26, 2015 arterial switch operation presented during the 3rd african association of cardiovascular and thoracic surgery training at the college of health sciences, university of nairobi. Although structural differences in the vessel wall of these patients may be of influence, we hypothesize that a histomorphologic difference in composition and embedding of the fibrous annulus in transposition of the great arteries may play a role in neoaortic root dilatation. Arterial switch operation jatene procedure legend 1. Merge pdf, split pdf, compress pdf, office to pdf, pdf to jpg and more. Anatomic repair for congenitally corrected transposition of the great.
Although the society of thoracic surgeons recently endorsed several quality metrics, it is not known. This paper aims to update clinicians on hot topics in the management of patients with dloop transposition of the great arteries dtga in the current surgical era. Recently reported opera despite advancement in the technical aspects of the procedure, certain anatomical variations of the coronary arteries, such as a single coronary orifice andor intramural coronary artery. Switch operation is good myocardial function at rest is normal stress testing may unmask regional wall abnormalities rvoto common complication reintervention rate 35% neoaortic root dilatation in 1st y of life normalizes within 10 y sign. Permanent treatment requires a surgical procedure to switch the arteries to their proper places. Definition of transposition of the great arteries healthzene. Almost all children with tga undergo the arterial switch repair also called the jatene repair. Transposition of the great arteries the patient guide to. Longterm fate of the aortic valve after an arterial switch operation mauro lo rito, md,a mario fittipaldi, md,a randula haththotuwa, md,b timothy j. The arterial switch operation for transposition of the great arteries richard a. If the patient is symptomatic, has elevated rv pressure or significant gradient therapy should be offered for branch pulmonary artery stenosis surgery should be offered as primary treatment and. This study is designed to assess recent outcomes after the aso in babies presenting with transposition of the great arteries tga and taussigbing anomaly tba.
Neoaortic root dilatation is observed after the arterial switch operation for transposition of the great arteries. Technical aspects of the combined arterial switch and. Coronary revascularization after arterial switch operation european. Mmcts surgical technique of double switch procedure. Current expectations of the arterial switch operation in a small volume center. Split a pdf file by page ranges or extract all pdf pages to multiple pdf files.
The arterial switch operation has become the surgery of choice for correcting transposition of the great arteries 1,2. The arterial switch procedure has gained acceptance in the treatment of neonates with transposition of the great arteries and vsd 3. Following aortic cross clamping, the ascending aorta and main pulmonary artery are transected. Pdfsam is written with java swing that is a set of java class libraries provided as part of java 2 platform. 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. Jun 07, 2012 the arterial switch operation is a simple concept. The arterial switch operation aso hasevolvedtobecomethetreatmentofchoiceformostformsof tga, andsuccess withthis operation has becomea standard bywhichpediatric cardiac surgical units are. 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. The pulmonary artery and aorta are transected and translocated so that the pulmonary. Even though it has been suggested neoaortic dilation will stabilise in adulthood, data are lacking. Prior to the development of this surgery, a surgery called an atrial switch or mustard procedure or senning procedure was used.
Pulmonary artery branch stenosis after the arterial switch operation. Pdf arterial switch operation with a single coronary. A single coronary artery, especially if associated with anterior looping, remains a risk factor when performing an arterial switch operation for transposition of the great arteries. The society of thoracic surgeons sts congenital heart surgery database shows an expected outcome of 1.
The flapis achieved bycreation ofa jshaped incision. Merge pdf documents or other files to one pdf file. Optimal timing for arterial switch in neonates with. The left and right coronary artery ostia are visualized and excised from the aortic root with adjacent aortic wall as buttons. 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. A median sternotomy incision through the middle of.
Intramural coronary arteries and outcome of neonatal arterial switch operation olivier metton, et al european journal of cardiothoracic surgery 37 2010 12461253. The aorta and the pulmonary artery are transected above the valves, moved to the correct position, and sewn in place. Jones, md,a natasha khan, md,a paul clift, md,b william j. The arterial switch operation surgery for congenital. New coronary transfer technique for transposition of the. This operation will require the use of cardiopulmonary bypass heartlung machine. Implications of early aortic stiffening in patients with transposition. Arterial switch operation for repair of transposition of the great arteries. View enhanced pdf access article on wiley online library html view download pdf for offline viewing.
Jun 11, 2016 evaluation of the adult with transposition after atrial or arterial switch operations i n the current era, the vast majority of infants born with complete transposition of the great arteries d tga undergo an arterial switch operation soon after birth. Soon after birth, babies with tga become very sick because of a severe lack of oxygen. Jonas transposition of the great arteries, together with tetral ogy of fallot, is one of the most common congenital cardiac anomalies resulting in cyanosis. Technique of coronary transfer for tga with single. Feb 09, 2017 surgical technique of double switch procedure. Arterial switch procedure radiology reference article. The modern repair that is preferred is called the arterial switch operation aso for short.
The medially based trapdoor flap is an alternative to excision ofanushaped area of tissue. In this surgical operation, the aorta and pulmonary artery are both moved to their normal position. Postoperative complications and their management after arterial switch operation in infants with transposition of great arteries lixing zhu, linhua tan, xiaojun he, caiyun zhang, yanping yu, zewei zhang hangzhou, china background. Coronary artery transfer without kinking or overstretching is the key to a successful arterial switch operation aso.
Although the arterial switch is a major surgical procedure, the results are excellent. We sought to determine the midterm results of this intervention. Transposition of the great arteries, dtype flash animation, less than 70kb. Guideline dtga arterial switch operation orphanet journal of rare diseases 2008,3. The arterial switch operation aso has replaced atrial switch procedures for dtga, and 90% of patients now reach adulthood. Compared with the mustard and senning repairs, correction at the arterial level restores the left ventricle as the systemic ventricle and offers improved outcome. Outflow obstruction after the arterial switch operation. Evaluation of the adult with transposition after atrial or.
It is an openheart procedure that requires a temporary stopping of the babys heart while a heartlung machine handles respiration and blood circulation. Postoperative complications and their management after. It allows the surgeon to reconstruct the right ventricular outflow tract without needing to connect the. Mortality is higher when there are additional defects like a hole in the heart vsd or narrowing of the arteries to the body aorta. The rapid twostage arterial switch operation springerlink. The arterial switch operation for transposition of the great. From july 1993april 2001, 117 infants underwent an arterial switch operation before 90 days of age. Cardiac outcomes in young adult survivors of the arterial. We analyzed hemodynamic variables in patients with transposition of the great arteries with intact ventricular septum simple transposition after pulmonary artery banding and blalocktaussig anastomosis to establish the criteria for twostaged arterial switch operation. N2 the arterial switch operation has been the principal treatment for transposition of the great arteries and its variants for the last 25 years. Split or extract pdf files online, easily and free.
Arterial switch operation definition of arterial switch. First performed successfully by jatene in 1976, the indications, timing, and. 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. The arterial switch operation aso has become the procedure of choice for correction of transposition of great arteries tga. Morbidity of the arterial switch operation sciencedirect. Since its introduction in the late 1970s, the arterial switch operation aso has become the gold standard for surgical repair of transposition of the great arteries tga in neonates and infants. Consequences of arterial switch operation in children born. Arterial switch operation patients uncommonly develop arrhythmia, with no more than 5% experiencing difficulties. Anatomical repair, combining a senning operation and an arterial switch operation or senning and rastelli operations while the term ds. Late complications following the arterial switch operation. Arterial switch operation aso arterial switch operation is used for repair of transposition of the great arteries tga.
Arterial switch operation aso an arterial switch operation is done to correct transposition of the great arteries tga with or without ventricular septal defect vsd see tga. Longterm survival and functional followup in patients after the arterial switch operation felix haas, md, michael wottke, md, holger poppert, and hans meisner, md department of cardiovascular surgery, german heart center of munich, munich, germany. An arterial switch operation is an openheart procedure. Arterial switch operation or arterial switch, is an open heart surgical procedure used to correct dextrotransposition of the great arteries dtga. Less than 2% develop complete heart block, most of whom had a ventricular septal defect in addition to the transposition. Pdf arterial switch operation for transposition of great. Design and initial results of a programme for routine standardised. Indications for the arterial switch operation management methodology for arterial switch surgical technique postoperative management results references. Coronary artery problems late after arterial switch.
A case of arterial switch operation with coronary elongation. The operative mortality associated with this operation has decreased with improvements in neonatal perfusion techniques and increasing operative experience 4. A median sternotomy incision through the middle of the chest is done. Arterial switch operation aso has been optimal for children with transposition of.
The difficulty with this operation is the coronary arteries. The arterial switch operation is currently the preferred surgical approach for complete transposition of the great arteries. Pulmonary artery branch stenosis after the arterial switch. Guideline dtga arterial switch operation wernovsky g, rome jj, tabbutt s, et al. The outflow tract in transposition of the great arteries. Association between variation in preoperative care before arterial. It has a simple graphical interface to let the user choose pdf files, split or merge them. The arterial switch operation aso has now replaced the atrial switch procedures developed by mustard and senning to manage dloop transposition of the great arteries dtga. Senning with arterial switch operation for congenitally corrected transposition of the great arteries with ventricular septal defect we present a.
The arterial switch operation in europe for transposition of the great arteries. The arterial switch operation aso has evolved from a pioneering neonatal procedure to a reproducible technique allowing anatomic repair of transposition of the great arteries tga and selected forms of doubleoutlet right ventricle dorv 1, 2, 3. Jun 17, 2009 the arterial switch operation has evolved into the treatment of choice for most forms of transposition of the great arteries tga. Transposition of the great arteries, dtype congenital. Current expectations of the arterial switch operation in a. In 1975, jatene and associates described the first successful arterial switch procedure in a patient with dtransposition of the great arteries and a large ventricu. 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. Pediatric center penn state hershey medical center. Current expectations for newborns undergoing the arterial. Revival and modification of the mustard operation the journal of.
The arterial switch operation aso represents a remarkable success story in the surgical treatment of cyanotic congenital heart disease. The arterial switch operation has become a standard surgical procedure for tga, and its current mortality risk is very low, even in cases with complex coronary arteries. Arterial switch operation with a single coronary artery. Implications of early aortic stiffening in patients with. A computational assessment of two arterial switch operations. Paediatric pulmonary arterial hypertension nice 2018. After identifying the proximal rca, a longitudinal atheretomy was performed extended towards the coronary ostium, joining the aortotomy. Late outcomes after arterial switch operation for taussig.
This procedure is typically done within the first week of life. Longterm survival and functional followup in patients after. It doesnt matter how complex they are or how many pages each pdf has, pdf2go merges them all into one. Criteria for twostaged arterial switch operation for. 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 surgical treatment of patients with transposi tion of the great arteries has undergone a dramatic change with the recent addition of the arterial switch operation. Approximately by 1 month of age, most patients with tgaivs have a peak lvrv pressure ratio equal to or less than 0. The aim of this study was to assess the change in neoaortic dimensions, prevalence of neoaortic dilation 40 mm and longterm outcome in adults who underwent aso in. To prove that the srga spiral relationship of the normally related great arteries arterial switch operation aso is hemodynamically superior to that of the lecompte. Arterial switch operation jatene procedure created date. Permanent treatment involves heart surgery during which the great arteries are cut and stitched back to their correct position. 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. Merged bilateral arterial duct and circumflex retroesophageal right aortic arch in a fetus.
The lecompte maneuver is a technique used in open heart surgery, primarily on infants and children. Atrial switch operation advantages first effective surgical treatments for tga aplication in complex cases of tga favourable immediate results shorter learning curve disadvantages must be familiar with the technique lot of details non anatomical correction different long term complications with difficult resolution. Current technique of the arterial switch procedure for. Ninetynine percent of the surgeries are successful. The arterial switch operation is appropriate treatment for most forms of transposition of the great arteries. Congenital heart defects 2 the arterial switch operation, also called the jatene procedure, is an operation in which surgeons redirect the flow of blood through abnormal hearts. Arterial switch operation olivier metton, et al european journal of cardiothoracic surgery 37 2010 12461253. Two arterial switch operations aso designed for transposition of great arteries with ventricular septal defect are numerically assessed. 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. Arterial switch is a surgical procedure and the main treatment to correct transposition of the great arteries tga. 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. Articles results of the arterial switch operation in. We track outcomes from common procedures as quality indicators for congenital heart surgery. Lallall tgal ivs tga with intact sptum t1mustards196373t2mustards197485karterial switch.
The arterial switch procedure requires cardiopulmonary bypass and aortic cross clamping. Arterial switch operation and complex coronary patterns. Objective after the arterial switch operation aso, disproportional neoaortic growth during childhood has been reported. The jatene procedure, arterial switch operation or arterial switch, is an open heart surgical procedure used to correct dextrotransposition of the great arteries dtga.
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