title: 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?
abstract: 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.
authors.affiliation: King Faisal Specialist Hospital and Research Center-Cardiac Surgery Intensive Care Unit, Jeddah, Saudi Arabia.
authors.forename: Noor Mohamed
authors.initials: NM
authors.lastname: Parker
authors.forename: Muhammed
authors.initials: M
authors.lastname: Zuhdi
authors.forename: Amjad
authors.initials: A
authors.lastname: Kouatli
authors.forename: Ghassan
authors.initials: G
authors.lastname: Baslaim
mesh_terms: 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