title: Mid-term results of a modified arterial switch operation using the direct reconstruction technique of the pulmonary artery.
abstract: BACKGROUND
  There is ongoing discussion as to whether it is beneficial to avoid pulmonary sinus augmentation in the arterial switch operation. We report a single-surgeon series of mid-term results for direct pulmonary artery anastomosis during switch operation for transposition of the great arteries (TGA).
  
  
  METHODS
  This retrospective study includes 17 patients with TGA, combined with an atrial septal defect, patent foramen ovale or ventricular septal defect. Patient data was analyzed from hospital charts, including operative reports, post-operative course, and regular follow-up investigations. The protocol included cardiological examination by a single pediatric cardiologist. Echocardiographic examinations were performed immediately after arrival on the intensive unit, before discharge, and then after three, six, and 12 months, followed by yearly intervals. Pulmonary artery stenosis (PAS) was categorized into three groups according to the Doppler-measured pulmonary gradient: grade I (trivial stenosis) = increased pulmonary flow with a gradient below 25 mm Hg; grade II (moderate stenosis) = a gradient ranging from 25 to 49 mm Hg; and grade III (severe stenosis) = a gradient above 50 mm Hg. Follow-up data was available for all patients. The length of follow-up ranged from 1.2 to 9.7 years, median: 7.5 years (mean 6.1 years ± 14 months).
  
  
  RESULTS
  During follow-up, 12 patients (70.6%) had no (or only trivial) PAS, five patients (29.4%) had moderate stenosis without progress, and no patient had severe PAS. Cardiac catheterization after arterial switch operation was performed in 11 patients (64.7%) and showed a good correlation with echocardiographic findings. During follow-up there was no reintervention for PAS.
  
  
  CONCLUSIONS
  Direct reconstruction of the neo-pulmonary artery is a good option in TGA with antero-posterior position of the great vessels, with very satisfactory mid-term results.
authors.affiliation: Department of cardiothoracic and Vascular Surgery, University Hopsital Mainz, Germany. kuroczynski@uni-mainz.de
authors.forename: Włodzimierz
authors.initials: W
authors.lastname: Kuroczyński
authors.forename: Christoph
authors.initials: C
authors.lastname: Kampmann
authors.forename: Ali Asghar
authors.initials: AA
authors.lastname: Peivandi
authors.forename: Marc
authors.initials: M
authors.lastname: Hartert
authors.forename: Markus
authors.initials: M
authors.lastname: Knuf
authors.forename: Markus K
authors.initials: MK
authors.lastname: Heinemann
authors.forename: Christian-Friedrich
authors.initials: CF
authors.lastname: Vahl
mesh_terms: D000015:Abnormalities, Multiple; D000714:Anastomosis, Surgical; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D003251:Constriction, Pathologic; D015150:Echocardiography, Doppler; D005260:Female; D005858:Germany; D006439:Hemodynamics; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome