title: Enhanced left ventricular training in corrected transposition of the great arteries by increasing the preload.
abstract: OBJECTIVE
  Patients with congenitally corrected transposition of the great arteries (ccTGA) without ventricular septal defect or left ventricular outflow tract obstruction need training of the morphological left ventricle (mLV) to undergo a double switch operation (DS) (atrial plus arterial switch). Establishing a sufficient gradient by pulmonary artery banding (PAB) is difficult and multiple re-pulmonary artery bandings (re-PABs) may be necessary to achieve the required physiology. We evaluate a new approach, consisting of a loose PAB in combination with an artificial atrial septal defect (aASD) to not only increase afterload but to dynamically enhance preload as well, in terms of the effectiveness of training of the mLV and the subsequent functional outcome after a DS.
  
  
  METHODS
  Six consecutive patients under 6 years of age with ccTGA, who were eligible for anatomical correction, underwent enhanced left ventricular training (eLVT). Four of these patients had failed to reach sufficient mLV pressure by PAB only.
  
  
  RESULTS
  Required systemic pressures in the mLV were achieved after a mean of 1.2 years of eLVT with no further re-PAB necessary in any patient. All patients underwent a successful DS with an uneventful postoperative period. At a mean follow-up period of 1.9 (range 0.4-3.8) years, stable LV cardiac function was observed in all patients.
  
  
  CONCLUSIONS
  The eLVT provides additional training of the mLV to bring patients to a DS. Even in situations when isolated conventional PAB is not effective enough, the novel combination of pressure and volume loading may help with LV retraining and reduce the need for sequential pulmonary band tightening.
authors.affiliation: Department of Cardiology, German Pediatric Heart Center, Sankt Augustin, Germany p.zartner@asklepios.com p.zartner@zartnet.de.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Zartner
authors.affiliation: Department of Cardiology, German Pediatric Heart Center, Sankt Augustin, Germany.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Schneider
authors.affiliation: Department of Cardiothoracic Surgery, German Pediatric Heart Center, Sankt Augustin, Germany.
authors.forename: Boulos
authors.initials: B
authors.lastname: Asfour
authors.affiliation: Department of Cardiothoracic Surgery, German Pediatric Heart Center, Sankt Augustin, Germany.
authors.forename: Viktor
authors.initials: V
authors.lastname: Hraška
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D002675:Child, Preschool; D000080041:Congenitally Corrected Transposition of the Great Arteries; D003250:Constriction; D019560:Echocardiography, Three-Dimensional / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000601:surgery; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D011651:Pulmonary Artery; D012086:Reoperation; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Atrial shunt; Double switch operation; Interval training; Left ventricular volume; ccTGA