title: Recurrent neoaortic insufficiency after the switch back operation with previous repair of transposition with ventricular septal defect and aortic arch hypoplasia.
abstract: Neoaortic insufficiency is not uncommon after the arterial switch operation (ASO) for d-Transposition, yet surgery is rarely required. In a patient with worsening neoaortic regurgitation post-arterial switch and ventricular septal defect (VSD) closure, we performed a successful "switch back" operation with documented aortic valve competence on discharge echocardiography. However, recurrent severe aortic insufficiency required valve replacement, and histopathology of the excised valve indicated abnormal leaflet/vascular wall structure. We question whether the switch back operation is a viable option for neoaortic insufficiency after an ASO in patients with previous d-Transposition and VSD, when the native pulmonary valve may have structural deficiencies.
authors.affiliation: Division of Pediatric and Congenital Heart Surgery, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Brister
authors.affiliation: Division of Pediatric Cardiology, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Shores
authors.affiliation: Division of Pediatric and Congenital Heart Surgery, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Jorge D
authors.initials: JD
authors.lastname: Salazar
authors.affiliation: Division of Pediatric and Congenital Heart Surgery, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: DiBardino
authors.affiliation: Department of Pathology, Children's Heart Center, University of Mississippi Medical Center, Jackson, MS, USA.
authors.forename: Josephine
authors.initials: J
authors.lastname: Wyatt-Ashmead
authors.affiliation: Division of Pediatric and Congenital Heart Surgery, University of Mississippi Medical Center, Jackson, MS, USA adodgekhatami@umc.edu.
authors.forename: Ali
authors.initials: A
authors.lastname: Dodge-Khatami
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery*; D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D002648:Child; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D014188:Transposition of Great Vessels / Q000601:surgery*; D014463:Ultrasonography
keywords: aortic valve replacement; arterial switch operation; outcomes; ventricular septal defect