Early prophylactic pulmonary artery banding in isolated congenitally corrected transposition of the great arteries.
OBJECTIVE
Mid-term evaluation of an aggressive surgical management of isolated congenitally corrected transposition of the great arteries (ccTGA) by pulmonary artery (PA) banding in early infancy.


METHODS
Between 2001 and 2009, 11 asymptomatic patients (seven neonates and four infants) underwent a dilatable, partially adjustable, homemade PA banding for ccTGA with intact ventricular septum. PA band circumference was correlated to body weight (22 mm+1 mm kg(-1)) and ideally adjusted to obtain flat septal geometry. Mean age at operation was 1.5±1.4 months.


RESULTS
There was no hospital mortality. Mean ventilation time and intensive care unit (ICU) stay were 20±9 h and 2.6±1.5 days, respectively. Five patients required postoperative inotropic support. One late death occurred suddenly at 4 months; normal biventricular function and no tricuspid regurgitation were noted at last follow-up, 1 week before death. Mean follow-up was 21.5±26 months. Mean band velocity increased over time from 2.65±0.7 m s(-1) postoperatively to 3.7±0.3 at 6 months and 4.5±0.4 m s(-1) at 2 years. Tricuspid regurgitation remained stable in seven patients, decreased in three and worsened in one. Flat septal geometry was obtained in all patients after the third postoperative month. One patient underwent a double-switch procedure at 7 years due to suprasystemic morphologically left ventricular pressure. The postoperative course was uneventful.


CONCLUSIONS
In neonates with isolated ccTGA, prophylactic PA banding is safe and carries a low morbidity. At mid-term evaluation, tricuspid valve function is stabilised or improved and systemic competence of the left ventricle is maintained, thus allowing double switch if indicated.
Metton
Olivier
O
Department of Pediatric Cardiac Surgery, University Paris Descartes and Necker Sick Children Hospital, Paris, France.
Gaudin
Régis
R
Ou
Phalla
P
Gerelli
Sébastien
S
Mussa
Shafi
S
Sidi
Daniel
D
Vouhé
Pascal
P
Raisky
Olivier
O
D000367:Age Factors; D001783:Blood Flow Velocity / Q000502:physiology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003250:Constriction; D003422:Critical Care; D004812:Epidemiologic Methods; D005260:Female; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D014188:Transposition of Great Vessels / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000209:etiology
D002316:Cardiotonic Agents