Prediction of early pulmonary artery stenosis after arterial switch operation: the role of intraoperative transesophageal echocardiography.
OBJECTIVE
To investigate prospectively the prediction of the neopulmonary stenosis (neo-PS) after arterial switch operation (ASO) for transposition of the great artery (TGA) with intraoperative transesophageal echocardiography (TEE).


METHODS
Infants with TGA undergoing the ASO were prospectively studied over 5 years. The neo-PS was defined when the peak flow velocity was over 3 m/s at the neo main pulmonary artery (neo-MPA) after ASO by TEE (TEEPS). Catheterization was performed if estimated peak neo-PS pressure gradient was over 40 mm Hg by transthoracic echocardiography. Balloon angioplasty was tried first and surgical reoperation was reserved for those with failed angioplasty.


RESULTS
In total 49 consecutive patients were enrolled into the cohort study. TEEPS was identified in 21 patients. For patients with TEEPS, freedom from reintervention was 28% at 1 year and 23% at 2 years. For patients without TEEPS, freedom from reintervention for PS was 92% at 1 year and 78% at 2 years. The time interval from ASO to reintervention was significantly shorter in patients with TEEPS than without TEEPS. Existence of TEEPS and non-Lecompte method were main risk factor for reintervention.


CONCLUSIONS
The present study demonstrated that the application of intraoperative TEE for infants undergoing ASO is very helpful in predicting the development of early postoperative neo-PS.
Chen
Yih-Sharng
YS
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Tsai
Shen-Ko
SK
Chang
Chung-I
CI
Chiu
Ing-Sh
IS
Wang
Jou-Ko
JK
Wu
Mei-Hwan
MH
Wang
Ming-Jiuh
MJ
D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000379:methods; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D011446:Prospective Studies; D011651:Pulmonary Artery; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology*; D014188:Transposition of Great Vessels / Q000150:complications* / Q000601:surgery; D016896:Treatment Outcome