Systemic right ventricular failure after atrial switch operation: midterm results of conversion into an arterial switch.
| Autor: | Daebritz SH; Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH, Aachen, Germany. sabine.daebritz@hch.med.uni-muenchen.de, Tiete AR, Sachweh JS, Engelhardt W, von Bernuth G, Messmer BJ |
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| Jazyk: | angličtina |
| Zdroj: | The Annals of thoracic surgery [Ann Thorac Surg] 2001 Apr; Vol. 71 (4), pp. 1255-9. |
| DOI: | 10.1016/s0003-4975(00)02662-x |
| Abstrakt: | Background: Failure of the systemic right ventricle after atrial switch operation can be treated by conversion into an arterial switch operation. Methods: Four patients, age 38 to 59 months, presented with right ventricular failure after Senning operation and ventricular septal defect closure. One patient had elevated left ventricular pressure; in the other three patients the left ventricle was retrained to a left ventricular/right ventricular pressure ratio of 0.8 or greater by pulmonary artery banding in 12 to 24 months. Results: Postoperative course after arterial switch operation was prolonged, but clinical condition was good at discharge. Fractional shortening ranged from 20% to 28%. Trace-to-moderate aortic regurgitation was present; only 1 patient had preserved sinus rhythm. After a mean follow-up of 43.5 months 1 patient had died due to left ventricular dysfunction. The survivors are in New York Heart Association functional class I to II. Fractional shortening has improved (29% to 37%); aortic regurgitation has not increased. No patient has undisturbed sinus rhythm. Conclusions: Conversion of an atrial into an arterial switch is an alternative to cardiac transplantation in childhood. However, the procedure is demanding. Long-term morbidity is caused by rhythm disturbances. Aortic valve performance and left ventricular function require close observation. |
| Databáze: | MEDLINE |
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