Early prophylactic pulmonary artery banding in isolated congenitally corrected transposition of the great arteries

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• 作者：Olivier Metton ; Ré ; gis Gaudin ; Phalla Ou ; Sé ; bastien Gerelli ; Shafi Mussa ; Daniel Sidi ; Pascal Vouhé ; Olivier Raisky
• 关键词：Congenital heart disease ; Congenitally corrected transposition of the great vessels ; Left ventricle retraining
• 刊名：European Journal of Cardio-Thoracic Surgery
• 出版年：2010
• 出版时间：December 2010
• 年：2010
• 卷：38
• 期：6
• 页码：728-734
• 全文大小：191 K

文摘

Objective: Mid-term evaluation of an aggressive surgical management of isolated congenitally corrected transposition of the great arteries (ccTGA) by pulmonary artery (PA) banding in early infancy. Methods: Between 2001 and 2009, 11 asymptomatic patients (seven neonates and four infants) underwent a dilatable, partially adjustable, homemade PA banding for ccTGA with intact ventricular septum. PA band circumference was correlated to body weight (22 mm + 1 mm kg⁻¹) and ideally adjusted to obtain flat septal geometry. Mean age at operation was 1.5 ± 1.4 months. Results: There was no hospital mortality. Mean ventilation time and intensive care unit (ICU) stay were 20 ± 9 h and 2.6 ± 1.5 days, respectively. Five patients required postoperative inotropic support. One late death occurred suddenly at 4 months; normal biventricular function and no tricuspid regurgitation were noted at last follow-up, 1 week before death. Mean follow-up was 21.5 ± 26 months. Mean band velocity increased over time from 2.65 ± 0.7 m s⁻¹ postoperatively to 3.7 ± 0.3 at 6 months and 4.5 ± 0.4 m s⁻¹ at 2 years. Tricuspid regurgitation remained stable in seven patients, decreased in three and worsened in one. Flat septal geometry was obtained in all patients after the third postoperative month. One patient underwent a double-switch procedure at 7 years due to suprasystemic morphologically left ventricular pressure. The postoperative course was uneventful. Conclusions: In neonates with isolated ccTGA, prophylactic PA banding is safe and carries a low morbidity. At mid-term evaluation, tricuspid valve function is stabilised or improved and systemic competence of the left ventricle is maintained, thus allowing double switch if indicated.