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L Talemal, M T Donofrio
D-transposition of the great arteries (D-TGA) is the most commonly diagnosed cyanotic congenital heart disease presenting in the neonatal period. The survival after an arterial switch operation, with freedom from adverse cardiovascular events, has been reported to be as high as 93% at 25 years. However, despite excellent surgical outcomes, there continues to be significant preoperative morbidity and potential mortality due to compromise in the delivery room from foramen ovale closure requiring urgent balloon atrial septostomy for stabilization in the first minutes of life...
September 16, 2016: Journal of Neonatal-perinatal Medicine
Konrad Paczkowski, Ireneusz Haponiuk, Maciej Chojnicki, Radosław Jaworski
We present a case of a 2.5-year-old-girl with complex congenital heart disease: tricuspid atresia (TA), bulboventricular septal defect (VSD), hypoplastic right ventricle, d-transposition of the great arteries (d-TGA) with aortic outflow from redundant RV. Due to II/III degree atrioventricular block induced after diagnostic cardiac catheterization, an epicardial pacemaker was implanted during the Glenn procedure. Because of severe left ventricle outflow tract obstruction, she was finally referred for extracardiac TCPC (extracardiac Fontan type) with recruitment of PV and Damus-Kaye-Stansel anastomosis...
2016: Heart Surgery Forum
Vincent J Schmithorst, Ashok Panigrahy, J William Gaynor, Christopher G Watson, Vince Lee, David C Bellinger, Michael J Rivkin, Jane W Newburger
OBJECTIVE: Little is currently known about the impact of congenital heart disease (CHD) on the organization of large-scale brain networks in relation to neurobehavioral outcome. We investigated whether CHD might impact ADHD symptoms via changes in brain structural network topology in a cohort of adolescents with d-transposition of the great arteries (d-TGA) repaired with the arterial switch operation in early infancy and referent subjects. We also explored whether these effects might be modified by apolipoprotein E (APOE) genotype, as the APOE ε2 allele has been associated with worse neurodevelopmental outcomes after repair of d-TGA in infancy...
August 2016: Brain and Behavior
David Backhoff, Gunter Kerst, Andrea Peters, Monika Lüdemann, Christian Frische, Michaela Horndasch, Gabriele Hessling, Thomas Paul, Ulrich Krause
BACKGROUND: Sudden cardiac death (SCD) is the most important cause of late mortality after atrial baffle procedure for d-transposition of the great arteries (d-TGA). Experience with internal cardioverter defibrillator (ICD) therapy in this population is limited. We conducted a multicenter cohort study to determine the current state of ICD therapy in individuals after atrial baffle procedure. METHODS: Demographic and clinical data as well as data on device implantation, programming, ICD discharges, and complications after atrial baffle procedure for d-TGA from four German centers were analyzed retrospectively...
October 2016: Pacing and Clinical Electrophysiology: PACE
Nathalie H P Claessens, Pim Moeskops, Andreas Buchmann, Beatrice Latal, Walter Knirsch, Ianina Scheer, Ivana Išgum, Linda S de Vries, Manon J N L Benders, Michael von Rhein
BACKGROUND: This study aimed to assess cortical gray matter growth and maturation in neonates with congenital heart disease (CHD). METHODS: Thirty-one (near) term neonates with severe CHD (8 univentricular heart malformation (UVH), 21 d-transposition of great arteries (d-TGA) and 2 aortic coarctation) underwent cerebral MRI before (postnatal-day 7) and after (postnatal-day 24) surgery. Eighteen controls with similar gestational age had one MRI (postnatal-day 23)...
August 24, 2016: Pediatric Research
Sachin Talwar, Manikala Vinod Kumar, Amolkumar Bhoje, Shiv Kumar Choudhary, Shyam Sunder Kothari, Rajnish Juneja, Anita Saxena, Balram Airan
OBJECTIVES: In developing countries, where patients present late, the atrial switch operation is still a preferred palliation for d-transposition of great arteries (d-TGA). In this report, we present our experience in patients with d-TGA who were 5 years of age or older. METHODS: Twenty-seven patients underwent an atrial switch procedure between January 2004 and December 2014. The standard technique consisted of a combination of the Senning and Mustard's repair with Schumacker's in situ modification for construction of the pulmonary venous baffle...
July 17, 2016: Interactive Cardiovascular and Thoracic Surgery
Yuji Nakajima
D-transposition of the great arteries (TGA) is one of the most common conotruncal heart defects at birth and is characterized by a discordant ventriculoarterial connection with a concordant atrioventricular connection. The morphological etiology of TGA is an inverted or arrested rotation of the heart outflow tract (OFT, conotruncus), by which the aorta is transposed in the right ventral direction to the pulmonary trunk. The rotational defect of the OFT is thought to be attributed to hypoplasia of the subpulmonic conus, which originates from the left anterior heart field (AHF) residing in the mesodermal core of the first and second pharyngeal arches...
September 2016: Congenital Anomalies
Emile C A Nyns, Andreea Dragulescu, Shi-Joon Yoo, Lars Grosse-Wortmann
Right ventricular (RV) volume and function evaluation is essential in the follow-up of patients after arterial switch operation (ASO) for dextro-transposition of the great arteries (d-TGA). Cardiac magnetic resonance (CMR) imaging using the Simpson's method is the gold-standard for measuring these parameters. However, this method can be challenging and time-consuming, especially in congenital heart disease. Knowledge-based reconstruction (KBR) is an alternative method to derive volumes from CMR datasets. It is based on the identification of a finite number of anatomical RV landmarks in various planes, followed by computer-based reconstruction of the endocardial contours by matching these landmarks with a reference library of representative RV shapes...
June 2, 2016: International Journal of Cardiovascular Imaging
Kai Ma, Shoujun Li, Shengshou Hu, Zhongdong Hua, Keming Yang, Jun Yan, Hao Zhang, Qiuming Chen, Sen Zhang, Lei Qi
BACKGROUND: Report results of neoaortic regurgitation (NAR) after arterial switch for patients with d-transposition of the great arteries (d-TGA) and corrected transposition of the great arteries. METHODS: From 2003 to 2013, 583 patients who underwent arterial switch operation for d-TGA and 31 patients who underwent double switch (DS) for congenitally corrected transposition of the great arteries (cc-TGA) were included in this retrospective study. Since 2011, concomitant neoaortic sinotubular junction reconstruction was performed if aorta and pulmonary artery discrepancy was present in patients with d-TGA...
August 2016: Annals of Thoracic Surgery
Magalie Ladouceur, Alban Redheuil, Gilles Soulat, Christophe Delclaux, Michel Azizi, Mehul Patel, Gilles Chatellier, Antoine Legendre, Laurence Iserin, Younes Boudjemline, Damien Bonnet, Elie Mousseaux
BACKGROUND: Systemic right ventricle (sRV) dysfunction in d-transposition of the great arteries following atrial switch (d-TGA) is associated with increased mortality. We aimed to characterize maladaptive sRV mechanisms in d-TGA patients, analyzing relation of echocardiographic parameters of sRV systolic function to objective measurements of exercise capacity. METHODS: Forty-seven adult patients with d-TGA and atrial switch (mean age 31.6±4.2years) underwent conventional echocardiography, bidimensional strain (2D-strain), cardiac magnetic resonance (CMR) imaging and cardiopulmonary exercise evaluation on the same day...
August 15, 2016: International Journal of Cardiology
Dai Kimura, Mario Briceno-Medina, T K Susheel Kumar, Christopher J Knott-Craig
Neonatal arterial switch operation for simple dextro-transposition of the great arteries (d-TGA) has almost eliminated the occurrence of pulmonary vascular obstructive disease compared to patients who underwent Mustard or Senning procedure at an older age. We report a case of a neonate with d-TGA and intact ventricular septum who underwent arterial switch operation and yet developed severe pulmonary vascular obstructive disease within two months.
April 20, 2016: World Journal for Pediatric & Congenital Heart Surgery
Adam R Cassidy, Matthew T White, David R DeMaso, Jane W Newburger, David C Bellinger
OBJECTIVE: To establish executive function (EF) structure/organization and test a longitudinal developmental cascade model linking processing speed (PS) and EF skills at 8-years of age to academic achievement outcomes, both at 8- and 16-years, in a large sample of children/adolescents with surgically repaired dextro-transposition of the great arteries (d-TGA). METHOD: Data for this study come from the 8- (n = 155) and 16-year (n = 139) time points of the Boston Circulatory Arrest Study and included WISC-III, Trail Making Test, Test of Variables of Attention, and WIAT/WIAT-II tasks...
October 2016: Neuropsychology
Magdalena Lipczyńska, Piotr Szymański, Olga Trojnarska, Lidia Tomkiewicz-Pająk, Bronisława Pietrzak, Anna Klisiewicz, Magdalena Kumor, Piotr Podolec, Piotr Hoffman
OBJECTIVE: We sought to identify maternal/neonatal and cardiovascular complications in pregnant women with complete transposition of great arteries (D-TGA) following atrial switch. METHODS: Clinical records of all women with D-TGA after the Mustard/Senning (M/S) operation who were followed at the three largest Adult Congenital Heart Disease (ACHD) centers in Poland were reviewed. RESULTS: Fifteen of the fifty-nine women followed had a total of 24 pregnancies, including two spontaneous miscarriages...
May 5, 2016: Journal of Maternal-fetal & Neonatal Medicine
Boguslaw Mazurek, Leslaw Szydlowski, Magdalena Mazurek, Grazyna Markiewicz-Loskot, Jacek Pajak, Aleksandra Morka
Children who underwent surgery for complex congenital heart defects present worse exercise capacity than their healthy peers. In adults and adolescents, heart failure is assessed on the basis of clinical symptoms using the New York Heart Association (NYHA) score, while in an infant Ross scale; heart failure can also be evaluated by other parameters. The purpose of this study was to compare the degree of exercise tolerance in children after surgery for complex heart defects, assessed by the ratio of maximum oxygen uptake (VO2max) and the brain natriuretic peptide (N-terminal fragment of the prohormone brain-type natriuretic peptide [NT-proBNP]) concentration...
February 2016: Medicine (Baltimore)
Ryan T Borne, Joseph Kay, Thomas Fagan, Duy Thai Nguyen
Catheter ablation for patients with transposition of the great arteries (d-TGA) requires multiple considerations and careful preprocedural planning. Knowledge of the patient's anatomy and surgical correction, in addition to electroanatomic mapping and entrainment maneuvers, are important to identify and successfully treat arrhythmias. This case was unique in that the lack of femoral venous access required transhepatic venous access and bidirectional block was attained with ablation lesions along the cavotricuspid isthmus on both sides of the baffle...
March 2016: Cardiac Electrophysiology Clinics
Nobuyuki Tsujii, Etsuko Tsuda, Yasuhide Asaumi, Osamu Yamada
Proximal stenosis adjacent to the orifice of one or both coronary arteries may occur after the arterial switch operation (ASO) for d-transposition of the great arteries (d-TGA). Coronary artery stenosis (CAS) often progresses within the first 6 months postoperatively and may result in myocardial ischemia and infarction. Although percutaneous transluminal coronary balloon angioplasty (PCBA) for CAS within 15 months after ASO for d-TGA has been reported, there is no report of PCBA for CAS in the late period after ASO...
April 2016: Pediatric Cardiology
Giovanni Di Salvo, Ziad Al Bulbul, Ziad Issa, Bahaa Fadel, Abdullah Al-Sehly, Valeria Pergola, Zohair Al Halees, Majid Al Fayyadh
BACKGROUND: The arterial switch operation (ASO) is nowadays the standard procedure for the repair of dextro-transposition of the great arteries (d-TGA). Reduced exercise capacity, coronary artery abnormalities, and reversible myocardial perfusion defects have been demonstrated in patients who have undergone ASO. Despite this, indices of systolic function, assessed by standard echocardiography, are within the normal range. Speckle-tracking echocardiography (STE) can detect early subclinical myocardial abnormalities in several diseases even in the presence of normal left ventricular (LV) ejection fraction...
March 2016: Journal of Cardiovascular Medicine
Alejandro J Torres, Doff B McElhinney, Brett R Anderson, Mariel E Turner, Matthew A Crystal, Donna M Timchak, Julie A Vincent
OBJECTIVE: To describe the significance of aortic root distortion (AD) and/or aortic valve insufficiency (AI) during balloon angioplasty of the right ventricular outflow tract (RVOT) performed to rule out coronary artery compression prior to transcatheter pulmonary valve (TPV) implantation. METHODS: AD/AI was assessed by retrospective review of all procedural aortographies performed to evaluate coronary anatomy prior to TPV implantation. AD/AI was also reviewed in all pre-post MPV implant echocardiograms to assess for progression...
April 2016: Journal of Interventional Cardiology
Pooja Mathur, Arvind Khare, Neena Jain, Priya Verma, Vivek Mathur
D-transposition of great arteries (D-TGA) is the most common cyanotic congenital heart disease diagnosed at birth. There is ventriculoarterial discordance leading to parallel circulation. The postnatal survival depends on intercirculatory mixing of oxygenated and deoxygenated blood at various levels through atrial septal defect, ventricular septal defect or patent ductus arteriosus. The anesthesiologist must have an understanding of concepts of shunting and other long-term consequences of transposition of great arteries (TGA) in order to tailor the anesthetic technique to optimize the hemodynamic variables and oxygenation in the perioperative period...
September 2015: Anesthesia, Essays and Researches
Michael B Stokes, Pankaj Saxena, David C McGiffin, Silvana Marasco, Angeline S Leet, Peter Bergin
A clinical case is described of a patient with a history of dextro-transposition of the great arteries (d-TGA) and prior atrial switch procedure who developed significant pulmonary hypertension whilst awaiting orthotopic cardiac transplantation. The increase in his pulmonary pressures necessitated de-listing for cardiac transplantation. A strategy of ventricular assist device (VAD) placement was then employed which provided improvement in his systemic cardiac output with left atrial off-loading to provide pulmonary vascular remodelling and consequently reduction in pulmonary vascular resistance (PVR)...
May 2016: Heart, Lung & Circulation
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