Outcomes of Morphologic Left Ventricle Retraining Procedure for Congenitally Corrected Transposition of the Great Arteries_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CUI Bin , LI Shoujun , YAN Jun , SHEN Xiangdong , WANG Xu , HUA Zhongdong , YANG Keming.

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Keywords：

Left ventricle retraining; 　Corrected transposition of the great arteries; 　Congenital heart disease

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Abstract：　Objective?To evaluate clinical experiences and long-term outcome of morphologic left ventricle （mLV） retraining for congenitally corrected　transposition of the great arteries （cCTGA）.　Methods　From May 2005 to May 2011, 24 patients with cCTGA anomaly underwent left ventricle retraining by means of pulmonary artery banding in Fu Wai Hospital. There were 13 males and 11 females with their age of 0.17-22.00 （3.73±4.35） years and body weight of 5.10-61.00（15.71±10.95）kg. Major concomitant malformations included tricuspid valve insufficiency （TR）in 23 patients （mild in 11 patients, moderate in 7 patients, severe in 5 patients）, restrictive ventricular septal defect in 18 patients, atrial septal defect in 5 patients, patent foramen ovale in 5 patients, patent ductus arteriosus in 4 patients, mild pulmonary stenosis in 5 patients, and aortic coarctation in 1 patient. All the patients were preoperatively diagnosed by echocardiography, cardiovascular angiography or cardiac catheterization. The mLV end diastolic diameter （mLVEDD） was 8-32（21.56±6.60）mm, posterior wall thickness of mLV was 2-7 （4.29±1.52）mm , mLV to morphologic right ventricle （mRV） pressure ratio （mLV/mRV） was 0.12-0.65 （0.41±0.12）. Pulmonary artery banding operation was performed through upper partial sternotomy or median sternotomy without circulatory arrest.　Results　The mLV/mRV pressure ratio reached to 0.57-0.93 （0.76±0.10） under direct pressure monitoring after surgery. There was no in-hospital death in this group.　Echocardiography before discharge showed that the structure and function of the two ventricles were good, the interventricular septum moved partially towards mRV, mLVEDD was increased slightly, and there was a tendency of reduced TR. Postoperative follows-up was from 1 to 35 months, and there was no late death during follow-up. All the patients were in good general condition with stable vital signs and New York Heart Association （NYHA） classⅠ-Ⅱ. The mLVEDD was 14-40 （26.17±7.11） mm, posterior wall thickness of mLV was 4-9 （4.95±1.44）mm, mLV/mRV pressure ratio was 0.52-0.98 （0.72±0.16） , and TR was significantly decreased. Fourteen patients successfully underwent staged complete double-switch procedure.　Conclusion　Left ventricle retraining is a safe and effective method to train mLV for cCTGA patients. Pressure load and posterior wall thickness of mLV are increased, mLV cavity is dilated, and TR is significantly reduced after the surgery.

Citation： CUI Bin,LI Shoujun,YAN Jun,SHEN Xiangdong,WANG Xu,HUA Zhongdong,YANG Keming.. Outcomes of Morphologic Left Ventricle Retraining Procedure for Congenitally Corrected Transposition of the Great Arteries. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(4): 350-353. doi: Copy

1.	Hornung TS， Calder L. Congenitally corrected transposition of the great arteries. Heart， 2010， 96 （14）：1154-1161.
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3.	Hörer J， Schreiber C， Krane S， et al. Outcome after surgical repair/palliation of congenitally corrected transposition of the great arteries. Thorac Cardiovasc Surg， 2008， 56 （7）：391-397.
4.	Bautista-Hernandez V， Marx GR， Gauvreau K， et al. Determinants of left ventricular dysfunction after anatomic repair of congenitally corrected　transposition of the great arteries. Ann Thorac Surg， 2006， 82 （6）：2059-2066.
5.	Devaney EJ， Charpie JR， Ohye RG， et al. Combined arterial switch and Senning operation for congenitally corrected transposition of the great arteries：patient selection and intermediate results. J Thorac Cardiovasc Surg， 2003， 125 （3）：500-507.
6.	Boutin C， Jonas RA， Sanders SP， et al. Rapid two-switch arterial switch operation.Acquisition of left ventricular mass after pulmonary artery banding in infants with transposition of the great arteries.　Circulation， 1994， 90 （3）：1304- 1309.
7.	Poirier NC， Yu JH， Brizard CP， et al. Long-term results of left ventricular reconditioning and anatomic correction for systemic right ventricular dysfunction after atrial switch procedures. J Thorac　Cardiovas Surg， 2004， 127 （4）：975-981.
8.	Winlaw DS， McGuirk SP， Balmer C， et al. Intention-to-treat analysis of pulmonary artery banding in conditions with a morphological right ventricle in the systemic circulation with a view to anatomic biventricular repair. Circulation， 2005， 111 （4）：405-411.
9.	Metton O， Gaudin R， Ou P， et al. Early prophylactic pulmonary artery banding in isolated congenitally corrected transposition of the great arteries. Eur J Cardiothorac Surg， 2010， 38 （6）：728-734.
10.	Quinn DW， McGuirk SP， Metha C， et al. The morphologic left ventricle that requires training by means of pulmonary artery banding before the double-switch procedure for congenitally corrected transposition of the great arteries is at risk of late dysfunction. J Thorac Cardiovasc Surg， 2008， 135 （5）：1137-1144.
11.	Honjo O， Kawada M， Akagi T， et al. Left ventricular retraining and anatomic correction in teenage patient with congenitally corrected transposition of the great arteries. Circ J， 2007， 71 （4）：613-616.
12.	Uno Y， Morita K， Ko Y， et al. Double switch operation for congenitally corrected transposition of the great arteries after two-staged pulmonary artery banding. Jpn J Thorac Cardiovasc Surg， 2006， 54 （1）：40-43.
13.	Corno AF， Ladusans EJ， Marco P， et al. Flowatch versus conventional pulmonary artery banding. J Thorac Cardiovasc Surg， 2007， 34 （6）：1413-1420.
14.	Ly M， Belli E， Leobon B， et al. Results of the double switch operation for congenitally corrected transposition of the great arteries. Eur J Cardiothorac Surg， 2009， 35 （5）：879-884.
15.	Marcy LS， Kimberlee G， Pedro del N， et al. Long-term predictors of aortic root dilation and aortic regurgitation after arterial switch　operation. Circulation， 2004， 110 （Suppl Ⅱ）：II128-II132.

1. 　Hornung TS， Calder L. Congenitally corrected transposition of the great arteries. Heart， 2010， 96 （14）：1154-1161.
2. 　Lim HG， Lee JR， Kim YJ， et al. Outcomes of biventricular repair for congenitally corrected transposition of the great arteries. Ann Thorac Surg， 2010， 89 （1）：159-167.
3. 　Hörer J， Schreiber C， Krane S， et al. Outcome after surgical repair/palliation of congenitally corrected transposition of the great arteries. Thorac Cardiovasc Surg， 2008， 56 （7）：391-397.
4. 　Bautista-Hernandez V， Marx GR， Gauvreau K， et al. Determinants of left ventricular dysfunction after anatomic repair of congenitally corrected　transposition of the great arteries. Ann Thorac Surg， 2006， 82 （6）：2059-2066.
5. 　Devaney EJ， Charpie JR， Ohye RG， et al. Combined arterial switch and Senning operation for congenitally corrected transposition of the great arteries：patient selection and intermediate results. J Thorac Cardiovasc Surg， 2003， 125 （3）：500-507.
6. 　Boutin C， Jonas RA， Sanders SP， et al. Rapid two-switch arterial switch operation.Acquisition of left ventricular mass after pulmonary artery banding in infants with transposition of the great arteries.　Circulation， 1994， 90 （3）：1304- 1309.
7. 　Poirier NC， Yu JH， Brizard CP， et al. Long-term results of left ventricular reconditioning and anatomic correction for systemic right ventricular dysfunction after atrial switch procedures. J Thorac　Cardiovas Surg， 2004， 127 （4）：975-981.
8. 　Winlaw DS， McGuirk SP， Balmer C， et al. Intention-to-treat analysis of pulmonary artery banding in conditions with a morphological right ventricle in the systemic circulation with a view to anatomic biventricular repair. Circulation， 2005， 111 （4）：405-411.
9. 　Metton O， Gaudin R， Ou P， et al. Early prophylactic pulmonary artery banding in isolated congenitally corrected transposition of the great arteries. Eur J Cardiothorac Surg， 2010， 38 （6）：728-734.
10. 　Quinn DW， McGuirk SP， Metha C， et al. The morphologic left ventricle that requires training by means of pulmonary artery banding before the double-switch procedure for congenitally corrected transposition of the great arteries is at risk of late dysfunction. J Thorac Cardiovasc Surg， 2008， 135 （5）：1137-1144.
11. 　Honjo O， Kawada M， Akagi T， et al. Left ventricular retraining and anatomic correction in teenage patient with congenitally corrected transposition of the great arteries. Circ J， 2007， 71 （4）：613-616.
12. 　Uno Y， Morita K， Ko Y， et al. Double switch operation for congenitally corrected transposition of the great arteries after two-staged pulmonary artery banding. Jpn J Thorac Cardiovasc Surg， 2006， 54 （1）：40-43.
13. 　Corno AF， Ladusans EJ， Marco P， et al. Flowatch versus conventional pulmonary artery banding. J Thorac Cardiovasc Surg， 2007， 34 （6）：1413-1420.
14. 　Ly M， Belli E， Leobon B， et al. Results of the double switch operation for congenitally corrected transposition of the great arteries. Eur J Cardiothorac Surg， 2009， 35 （5）：879-884.
15. 　Marcy LS， Kimberlee G， Pedro del N， et al. Long-term predictors of aortic root dilation and aortic regurgitation after arterial switch　operation. Circulation， 2004， 110 （Suppl Ⅱ）：II128-II132.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Outcomes of Morphologic Left Ventricle Retraining Procedure for Congenitally Corrected Transposition of the Great Arteries

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