title: Late results after extended pulmonary artery reconstruction in the arterial switch operation.
abstract: BACKGROUND
  Pulmonary artery stenosis remains the most frequent late complication and cause of reintervention after the arterial switch operation for transposition of the great arteries. We investigated the influence of an extended pericardial patch augmentation of the neopulmonary root and pulmonary artery on late pulmonary artery stenosis development.
  
  
  METHODS
  Augmentation of the neopulmonary root and pulmonary artery was achieved by reconstructing the posterior wall using a large glutaraldehyde-treated autologous pericardial patch. Reviewed were regular follow-up echocardiograms from 58 out of 87 patients undergoing the arterial switch operation who presented a follow-up period of at least 5 years. An actual follow-up echocardiographic evaluation focusing on the maximal instantaneous transpulmonary continuous-wave (cw)-Doppler gradient was performed, followed by cardiac catheterization when indicated (peak cw-Doppler gradient > 40 mm Hg).
  
  
  RESULTS
  Follow-up was 8.9 [5 to 15] years. There was no reintervention due to residual pulmonary artery stenosis. Actual Doppler examination revealed a transpulmonary peak gradient of 19.5 [0 to 56] mm Hg, compared with 20 [0 to 60] mm Hg at discharge. Forty-three patients (74.1%) had no or only trivial pulmonary artery stenosis (pressure gradient < 25 mm Hg), 14 patients (24.2%) had mild stenosis (25 to 49 mm Hg), and 1 patient (1.7%) had moderate stenosis (50 to 79 mm Hg).
  
  
  CONCLUSIONS
  Compared with the majority of literature data, we could demonstrate a low incidence of late pulmonary artery stenosis after the arterial switch operation by employing an extended pericardial patch reconstruction technique with augmentation of the neopulmonary root and pulmonary artery.
authors.affiliation: Department of Cardiac Surgery, University Medical Center, University of Heidelberg, Heidelberg, Germany. michael.ullmann@web.de
authors.forename: Michael V
authors.initials: MV
authors.lastname: Ullmann
authors.forename: Matthias
authors.initials: M
authors.lastname: Gorenflo
authors.forename: Christian
authors.initials: C
authors.lastname: Bolenz
authors.forename: Christian
authors.initials: C
authors.lastname: Sebening
authors.forename: Michael
authors.initials: M
authors.lastname: Goetze
authors.forename: Raoul
authors.initials: R
authors.lastname: Arnold
authors.forename: Herbert E
authors.initials: HE
authors.lastname: Ulmer
authors.forename: Siegfried
authors.initials: S
authors.lastname: Hagl
mesh_terms: D001705:Bioprosthesis; D001783:Blood Flow Velocity; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010496:Pericardium; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D013536:Suture Techniques; D014188:Transposition of Great Vessels / Q000601:surgery*; D016896:Treatment Outcome