title: Comparative analysis of early and middle outcomes of the arterial switch operation in children with complete transposition of the great arteries with ventricular septal defect and severe pulmonary artery hypertension.
abstract: BACKGROUND
  The best age for the arterial switch operation (ASO) in complete transposition of great arteries with ventricular septal defect is usually considered to be within six months. This is because of severe pulmonary arterial hypertension and pulmonary arterial obstructive pathological changes. There are few reports on ASO surgery in children older than three years old.
  
  
  METHODS
  We studied 41 children, including 24 males and 17 females, from January 2010 to December 2011. They were divided into three groups by operation age; 15 patients were < 1 year old, 13 were 1 - 3 years old, and 13 were > 3 years old. Associated cardiac abnormalities included patent ductus arteriosus in six cases, atrial septal defect in five cases, and mitral regurgitation in two cases. All the patients had echocardiography before the operation. Seventeen patients underwent a coronary computed tomography examination and five patients underwent right heart catheterization. All ASO surgeries were performed under inhalation anesthesia and hypothermic cardiopulmonary bypass.
  
  
  RESULTS
  Three operative deaths occurred. Two were in the < 1 year old group, who died from severe postoperative low cardiac output. The other was two years old and died of postoperative multiple organ failure. There was no significant difference in postoperative mortality and the recent mid-term survival rate among the three groups. Thirty-eight cases were followed up for an average of 11.2 months, ranging 6 - 20 months. One seven years old patient died of acute diarrhea and electrolyte disturbance arrhythmia caused by food poisoning. Three patients more than three years old still had residual pulmonary arterial hypertension.
  
  
  CONCLUSIONS
  Children older than three years old can still undergo the ASO procedure, but residual pulmonary hypertension is present.
authors.affiliation: Department of Pediatric Cardiology, Beijing An Zhen Hospital Affiliated to Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
authors.forename: Cheng-hu
authors.initials: CH
authors.lastname: Liu
authors.forename: Jun-wu
authors.initials: JW
authors.lastname: Su
authors.forename: Zhi-qiang
authors.initials: ZQ
authors.lastname: Li
authors.forename: Xiang-ming
authors.initials: XM
authors.lastname: Fan
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
authors.forename: Yan
authors.initials: Y
authors.lastname: He
authors.forename: Ying-long
authors.initials: YL
authors.lastname: Liu
mesh_terms: D001011:Aorta / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003331:Coronary Vessels / Q000601:surgery; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000601:surgery*; D007223:Infant; D008297:Male; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery; D014188:Transposition of Great Vessels / Q000601:surgery*; D016896:Treatment Outcome