title: Intermediate-term clinical and hemodynamic results of the neonatal arterial switch operation for complete transposition of the great arteries.
abstract: We prospectively evaluated 49 consecutive hospital survivors of the arterial switch operation for complete transposition and intact ventricular septum by clinical examination, echocardiography, cardiac catheterization, 12-lead and 24-h Holter ECG. The mean length of follow-up was 40 +/- 18 months. Forty-six children are clinically asymptomatic without medication, 2 died due to coronary related left ventricular dysfunction 3 and 12 months after surgery, and 1 required reoperation because of severe bilateral pulmonary branch stenoses. Except for this case, cardiac catheterization (n = 23) revealed a mean gradient of only 17 +/- 8 mmHg between the right ventricle and distal pulmonary arteries. Left ventricular end-diastolic volume was within normal limits except for 2 cases with volumes slightly below normal, the mean ejection fraction was 78 +/- 5%, and end-diastolic and end-systolic ventricular shapes were normal. The mean cardiac index was 4.14 +/- 0.69 l/min/m2. Left ventricular end-systolic wall stress to velocity of fiber shortening relation was normal in all cases examined (n = 15), indicating normal myocardial contractility. Significant neoaortic valve insufficiency was never observed despite considerably enlarged aortic roots. Twenty-four-hour Holter ECG records (n = 46) provided no evidence of serious atrial arrhythmias, especially sinus node dysfunction. These encouraging intermediate-term results make the arterial switch operation the treatment of choice at present, for neonates with simple transposition.
authors.affiliation: Department of Pediatric Cardiology, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: H H
authors.initials: HH
authors.lastname: Kramer
authors.forename: S
authors.initials: S
authors.lastname: Rammos
authors.forename: A
authors.initials: A
authors.lastname: Krian
authors.forename: O
authors.initials: O
authors.lastname: Krogmann
authors.forename: J
authors.initials: J
authors.lastname: Ostermeyer
authors.forename: B
authors.initials: B
authors.lastname: Korbmacher
authors.forename: R
authors.initials: R
authors.lastname: Buhl
mesh_terms: D002675:Child, Preschool; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D011446:Prospective Studies; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right