Successful late reintervention after the arterial switch procedure.
BACKGROUND
The arterial switch operation is the therapy of choice for transposition of the great arteries.


METHODS
A retrospective analysis of all children undergoing the arterial switch operation between November 1985 and October 2000 was conducted, highlighting the frequency and nature of late invasive reintervention.


RESULTS
One hundred forty-four children were operated on. Operative survival was 89% (128 of 144). Late reintervention was required in 23% (29 of 128) of survivors. Neopulmonary stenosis (PS) was the most common complication requiring treatment, occurring in 16% (21 of 128) of patients. Eleven of 21 patients with PS required reoperation, whereas 10 were managed with percutaneous techniques. Other indications for reintervention included aortic arch obstruction (3 patients), ventricular septal defect (with PS in 2 patients), bronchial stenosis (2 patients), coronary stenosis (2 patients), aortic stenosis (with PS in 1 patient), and residual atrial septal defect (1 patient). There has been no mortality or major morbidity in those children who have undergone reintervention.


CONCLUSIONS
Invasive reintervention after the arterial switch operation is occasionally required. The most common indication is PS. Reintervention is well tolerated by those children who require it. Continued follow-up for late complications is required in this patient population.
Gandhi
Sanjiv K
SK
Department of Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh, Pennsylvania 15213-2583, USA. gandhis@heart.chp.edu
Pigula
Frank A
FA
Siewers
Ralph D
RD
D006345:Heart Septal Defects, Ventricular / Q000150:complications; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011666:Pulmonary Valve Stenosis / Q000209:etiology / Q000628:therapy; D012086:Reoperation; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000150:complications / Q000601:surgery*