Late presenters with dextro-transposition of great arteries and intact ventricular septum: to train or not to train the left ventricle for arterial switch operation?
OBJECTIVE
We report our experience in managing late presenters (older than 4 weeks) with dextro-transposition of great arteries and intact ventricular septum (d-TGA/IVS) in an effort to achieve successful arterial switch operation (ASO) in a third world setting.


METHODS
We retrospectively reviewed the charts of all late presenters with d-TGA/IVS. Patients were divided into two groups: left ventricular training (LVT) group and non-left ventricular training (non-LVT) group. LVT group underwent pulmonary artery banding and Blalock-Taussig Shunt prior to ASO.


RESULTS
Twenty-one late presenters were included in the study. In LVT group, 11 patients with median age of 6 months (range, 1-72 months) underwent LVT. Later, 8 patients with median age of 9.25 months (range, 1.33-84 months) underwent ASO. Prior to ASO, left ventricle (LV) collapse resolved in all and left ventricle to systemic pressure (LV/SP) ratio was 0.81 (range, 0.76-0.95) in 4 patients. Two patients who had LVT for < or =14 days required postoperative extracorporeal membrane oxygenation (ECMO) support due to LV dysfunction. Seven patients survived to discharge. In non-LVT group, 10 patients with median age of 2.5 months (range, 1-98 months) underwent ASO. Five patients had LV collapse, and median LV/SP ratio was 0.67 (range, 0.56-1.19) in 5 patients. Seven patients needed ECMO support. Seven patients survived to discharge.


CONCLUSIONS
Late presenters with d-TGA/IVS, who have LV collapse on echocardiography and/or a LV/SP ratio <0.67 on cardiac catheterization, should be subjected to LVT preferably for duration of longer than 14 days in order to avoid potential ECMO use.
Parker
Noor Mohamed
NM
King Faisal Specialist Hospital and Research Center-Cardiac Surgery Intensive Care Unit, Jeddah, Saudi Arabia.
Zuhdi
Muhammed
M
Kouatli
Amjad
A
Baslaim
Ghassan
G
D000222:Adaptation, Physiological; D013504:Cardiovascular Surgical Procedures; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000517:prevention & control*; D016277:Ventricular Function, Left; D017725:Ventricular Pressure; D054088:Ventricular Septum