title: Arterial switch in the first hours of life: no need for Rashkind septostomy?
abstract: OBJECTIVE
  We describe our experience of arterial switch operation (ASO) in the first hours of life in children with D-transposition of the great arteries (TGA) intact ventricular septum and restrictive patent foramen ovale (PFO) with severe metabolic disorders. The Rashkind procedure is the usual strategy to stabilize critically ill patient before surgery. We assume that primary ASO is also the safe option.
  
  
  METHODS
  Between 2008 and 2010, 44 neonates underwent ASO. Of these, eight with simple D-TGA had severe acid-base disorders and form the subject of this report. All were operated on within the first 24 h of life. Median time from birth to admission to the hospital was 4 h 52 min. All patients had prenatal diagnoses. In six cases, childbirths were held in a maternity hospital near the heart surgery centre. In two cases, patients were transported from remote hospitals. All patients received prostaglandin E(l), three of them required ventilator support. All patients had small PFO (1-3 mm), oxygen saturation 60-85%. All had metabolic acidosis (pH ranging 6.96-7.2); lactate was increased in all patients (ranging 5.5-17.0 mmol/l).
  
  
  RESULTS
  All patients underwent primary ASO. We used normothermic cardiopulmonary bypass (CPB). Median CPB time was 143 min, and median ischaemic time was 68 min. All patients had uneventful postoperative periods. There were no in-hospital deaths and no late deaths after hospital discharge.
  
  
  CONCLUSIONS
  ASO for D-TGA in the first hours of life is a good option for the treatment of critically ill neonates with metabolic disorders. In our experience, there is no need for the Rashkind procedure to stabilize the patient before surgery.
authors.affiliation: Department of Pediatric Heart Surgery, State Centre for Cardiovascular Surgery, Penza, Russia. cardiotim@mail.ru
authors.forename: Timofey
authors.initials: T
authors.lastname: Nevvazhay
authors.forename: Alexey
authors.initials: A
authors.lastname: Chernogrivov
authors.forename: Evgeny
authors.initials: E
authors.lastname: Biryukov
authors.forename: Lyajlya
authors.initials: L
authors.lastname: Biktasheva
authors.forename: Kristina
authors.initials: K
authors.lastname: Karchevskaya
authors.forename: Shahriyar
authors.initials: S
authors.lastname: Sulejmanov
authors.forename: Julia
authors.initials: J
authors.lastname: Kalinicheva
authors.forename: Nikolay
authors.initials: N
authors.lastname: Artemiev
mesh_terms: D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000379:methods; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D004638:Emergency Treatment; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006346:Heart Septum / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D019564:Unnecessary Procedures; D014656:Vascular Surgical Procedures / Q000379:methods