title: Long term follow-up of left ventricular performance and size of the great arteries before and after one- and two-stage arterial switch operation of simple transposition.
abstract: OBJECTIVE
  Long-term angiographic evaluation of left ventricular performance and size of the great arteries after one-stage neonatal versus two-stage arterial switch operation (ASO) of simple transposition.
  
  
  METHODS
  Analysis of cineangiographic studies obtained during the process of two-stage ASO for 34 patients and after neonatal repair for 52 patients.
  
  
  RESULTS
  At early follow-up after two-stage ASO the left ventricular enddiastolic volume (LVEDV) was +1.8 standard deviations (S.D.) larger than LVEDV of control patients, but normalized completely (0.0 S.D.) at late follow-up. In contrast, after neonatal repair the LVEDV was always normal, and the median EF was significantly higher than after two-stage ASO (73 vs. 68%). The diameters of the native pulmonary annulus and sinus increased significantly after pulmonary artery banding to +4.5 and +4.8 S.D., respectively. After ASO, a significant decrease of the respective sizes occurred from early to late follow-up (annulus: +6.0 to +2.1 S.D.; sinus: +7.1 to +4.1 S.D.). After neonatal ASO the neoaortic annulus and sinus were only +1.5 and +2.7 S.D. larger than the comparable normal structures. The differences to the two-stage group were significant. In both groups, the neoaortic anastomosis had no diameters significantly different from normal. After one- and two-stage repair, the size of the neopulmonary annulus and sinus decreased similarly in both groups from early to late follow-up (annulus +0.9 to -2.4 S.D.; +0.3 to -2.8 S.D.; sinus: -0.7 to -1.6 S.D.; -0.7 to -1.8 S.D.).
  
  
  CONCLUSIONS
  Neonatal ASO has definite advantages over two-stage repair concerning LV-performance and the degree of dilation of the neoaortic root. The significantly reduced size of the neopulmonary root after both procedures is remarkable, but fortunately mostly without clinical significance.
authors.affiliation: Department of Pediatric Cardiology, Christian Albrechts University, Schwanenweg 20, 24105, Kiel, Germany. kramer@pedcard.uni-kiel.de
authors.forename: Hans-Heiner
authors.initials: HH
authors.lastname: Kramer
authors.forename: Jens
authors.initials: J
authors.lastname: Scheewe
authors.forename: Gunther
authors.initials: G
authors.lastname: Fischer
authors.forename: Anselm
authors.initials: A
authors.lastname: Uebing
authors.forename: Peter
authors.initials: P
authors.lastname: Harding
authors.forename: Friedrich
authors.initials: F
authors.lastname: Schmiel
authors.forename: Jochen
authors.initials: J
authors.lastname: Cremer
mesh_terms: D001011:Aorta / Q000473:pathology; D006348:Cardiac Surgical Procedures / Q000379:methods; D002675:Child, Preschool; D002932:Cineangiography; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D007223:Infant; D011184:Postoperative Period; D011651:Pulmonary Artery / Q000473:pathology; D014188:Transposition of Great Vessels / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D016277:Ventricular Function, Left