Late Manifestation of Coarctation of the Aorta After Arterial Switch Operation for D-Transposition of the Great Arteries With Intact Ventricular Septum

Division of Cardiothoracic Surgery, Department of Surgery, The American Family Children's Hospital, University of Wisconsin, Madison, WI, USA.
Pediatric Cardiology (Impact Factor: 1.31). 05/2012; 34(3). DOI: 10.1007/s00246-012-0332-6
Source: PubMed


We describe an infant with D-transposition of the great arteries with an intact ventricular septum who developed coarctation of the aorta 13 days after arterial switch operation. A mildly hypoplastic aortic isthmus was present on echocardiogram at the time of the arterial switch operation, but there was no echocardiographic or clinical evidence of coarctation of the aorta.

5 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: We report on three patients with kinking in the proximal aortic arch that developed after Lecompte modification of the arterial switch operation. Two patients had a previous subclavian patch repair of coarctation of the aorta and had an associated hypoplasia of the transverse aortic arch, and one patient had hemodynamically mild coarctation at the anatomical repair. A severe pressure gradient across the kinked area ("neo-coarctation") necessitating reoperation developed in one patient. The acute arch angulation appears to be due to an excessive posterior displacement of the ascending aorta by the anterior relocation of either the right or left main pulmonary artery branch from underneath the aortic arch. A foreshortened and frequently hypoplastic transverse aortic arch, a common association with coarctation of the aorta, appears to be especially vulnerable to the development of "neo-coarctation" after the Lecompte modification of the anatomical repair of transposed great arteries.
    Journal of Thoracic and Cardiovascular Surgery 03/1987; 93(2):276-80. · 4.17 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Neo-coarctation following arterial switch operation (ASO) for transposition of the great arteries (TGA) is a complication that is not regularly described, but may occur. We describe five patients who developed a neo-coarctation after operation. They were diagnosed with TGA, either with or without ventricular septal defect without signs or symptoms of a coarctation. Except for one patient, all patients were reoperated for a neo-coarctation within one year after the ASO. Several explanations are discussed as a possible cause for this phenomenon.
    Interactive Cardiovascular and Thoracic Surgery 06/2011; 13(3):339-40. DOI:10.1510/icvts.2011.265959 · 1.16 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Between January 1983 and December 1987, 62 patients underwent an arterial switch operation for transposition of the great arteries with ventricular septal defect or double outlet right or left ventricle. There were three hospital deaths (4.8%), and no deaths occurred in neonates (less than 1 month of age, n = 18). There were three late deaths, one due to coronary obstruction and two due to pulmonary vascular obstructive disease. One child has been lost to follow-up. We have prospectively evaluated the remaining 55 survivors by clinical evaluation, echocardiography, cardiac catheterization, ambulatory electrocardiographic monitoring, and limited electrophysiologic studies. The mean length of follow-up has been 27 +/- 16 months since surgery. One child has required reoperation for a residual ventricular septal defect; no child has undergone reoperation for supravalvar pulmonary or aortic stenosis. Aortic regurgitation was identified in 12 children (22%), which was mild in 11 and moderate in one. One child has asymptomatic occlusion of the left main coronary artery, one child has a tiny right coronary artery-to-pulmonary artery fistula, and one child has abnormal left ventricular wall motion according to follow-up angiography. No other abnormalities of systemic (left) ventricular function have been identified at late follow-up. In addition to the two late deaths due to pulmonary vascular obstructive disease, three children, all of whom were repaired at more than 6 months of age, have elevated pulmonary vascular resistance. Notable postoperative arrhythmias include complete heart block in four patients and nonsustained supraventricular or ventricular tachycardia early after surgery in eight patients (all resolved without medication at later follow-up). Only two patients have evidence of sinus node dysfunction and have not required treatment. The low hospital mortality and encouraging early follow-up data represent a significant improvement over atrial level repairs, supporting the arterial switch operation as the procedure of choice for children who have transposition of the great arteries with ventricular septal defect or double outlet ventricle. Because of the potential for the development of early pulmonary vascular obstructive disease in these patients, repair is recommended within the first 2 months of life.
    Circulation 01/1990; 80(6):1689-705. DOI:10.1161/01.CIR.80.6.1689 · 14.43 Impact Factor