title: Morphology, surgical techniques, and outcomes in patients above 15 years undergoing surgery for congenitally corrected transposition of great arteries.
abstract: BACKGROUND
  There is a paucity of data about morphology, surgical procedure, and results in older patients with congenitally corrected transposition of great arteries (ccTGAs).
  
  
  METHODS
  Between January 2002 and August 2012, 15 patients (7 males), median age 25 years, range 16 to 41 years underwent surgery for ccTGA. Associated lesions were tricuspid regurgitation (TR; n = 5) and ventricular septal defect (VSD) with pulmonary stenosis (PS; n = 10). Surgical procedures included tricuspid valve replacement (n = 4), tricuspid valve repair (n = 1), lateral tunnel Fontan (n = 2), extracardiac Fontan (n = 2), Kawashima procedure (n = 1), bidirectional (BD) Glenn (n = 2), Senning + Rastelli procedure (n = 1), and VSD closure + left ventricle to pulmonary artery conduit (n = 1). The details of these procedures and outcomes were analyzed.
  
  
  RESULTS
  There were no early or late deaths. Mean follow-up period was 49.9 ± 26 months. All patients who underwent tricuspid valve replacement are in New York Heart Association (NYHA) class I, with no progression of right ventricular (RV) dysfunction. One patient who underwent tricuspid valve repair is in NYHA class III and has progressed to severe RV dysfunction. None of the patients undergoing single ventricle palliation had any complications related to the surgery. Both patients who underwent anatomical and physiological biventricular (BV) repair had no complications.
  
  
  CONCLUSIONS
  Older patients with ccTGA present a challenge. Fontan/BD Glenn remains a good option for patients who presented with VSD PS. Both anatomic and physiological BV repairs provide acceptable results. Tricuspid valve replacement is safe for patients presenting with TR who have improvement in functional class, though the right ventricular function may not improve.
authors: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors: Sachin
authors: S
authors: Talwar
authors: Tammem
authors: T
authors: Ahmed
authors: Anita
authors: A
authors: Saxena
authors: Shyam Sunder
authors: SS
authors: Kothari
authors: Rajnish
authors: R
authors: Juneja
authors: Balram
authors: B
authors: Airan
mesh_terms: D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D000080041:Congenitally Corrected Transposition of the Great Arteries; D005260:Female; D005500:Follow-Up Studies; D006343:Heart Septal Defects / Q000150:complications / Q000601:surgery; D006801:Humans; D008297:Male; D011666:Pulmonary Valve Stenosis / Q000150:complications / Q000601:surgery; D014188:Transposition of Great Vessels / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000601:surgery; D055815:Young Adult
keywords: bidirectional Glenn (BD Glenn); congenitally corrected transposition of great arteries (ccTGA); tricuspid valve repair; tricuspid valve replacement (TVR)