TY - EJOU
AU - Bilal, Mehmet Salih
AU - Arda Özyüksel,
AU - Avşar, Mustafa Kemal
AU - Şener Demiroluk,
AU - Osman Küçükosmanoğlu,
AU - Yalım Yalçın,
TI - A better approach for left ventricular training in transposition of the great arteries and intact interventricular septum: Bidirectional cavopulmonary anastomosis and pulmonary artery banding
T2 - Congenital Heart Disease
PY - 2019
VL - 14
IS - 3
SN - 1747-0803
AB - Objective: Management of the patients with transposition of the great arteries and
intact ventricular septum may be challenging beyond the newborn period. Herein, we
would like to present our alternative strategy for training the left ventricle in these
patients.
Methods: Six patients with transposition of the great arteries and intact ventricular
septum were evaluated in our clinic. Two of them were palliated with Glenn procedure and pulmonary banding as a definitive treatment strategy at other centers. Four
patients were operated on and a bidirectional cavopulmonary anastomosis in combination with pulmonary artery banding was performed (stage‐1: palliation and ventricular training) in our center. In four out of these six patients, arterial switch
operation was performed with takedown and direct re‐anastomosis of the superior
vena cava to right atrium after an interstage period of 21‐30 months (stage‐2: anatomical repair).
Results: Any mortality was not encountered. The left ventricular mass indices increased from 18‐32 to 44‐74 g/m2
in patients undergoing the anatomical repair. All
of the patients were uneventfully discharged following the second stage. The mean
follow‐up period was 20 months (9‐32 months) following stage 2. All of the patients
are doing well with trivial neoaortic regurgitation and normal biventricular function.
Conclusions: Bidirectional cavopulmonary anastomosis with pulmonary artery banding may be a promising left ventricle training approach in ventriculoarterial discordance when compared to the traditional pulmonary artery banding with concomitant
systemic‐to‐pulmonary artery shunt procedures which still carry a significant interstage morbidity and mortality.
KW - arterial switch operation
KW - bidirectional Glenn procedure
KW - intact ventricular septum
KW - modified Blalock–Taussig shunt
KW - transposition of the great arteries
DO - 10.1111/chd.12749