Arterial switch. Mid-term follow up, eleven years of experience

pp 107-111

Abstract

Work objective

To evaluate the short and mid-term outcome after arterial switch operation in infants with transposition of the great arteries (TGA). 

Research Design and Methods

Between 1992-2003, 122 patients were discharged from hospital after an arterial switch operation. One hundred and one patients were followed-up between 6 months and 11 years, median: 4 years. Morphologic features: Simple TGA: 75; TGA and VSD: 36; Taussing-Bing anomaly: 9; TGA + VSD and pulmonary stenosis: 2; an anatomic variant from the usual coronary artery pattern was noted in 17 patients (13.9%). 

Results

All survivors remained in NHYA funcional class I. Supravalvular pulmonary stenosis was detected in 25 children (24.7%), considered severe in 10 (9.9%). Nine of these underwent surgery to relieve the pulmonary obstruction. A pulmonary angioplasty was later required in 2 patients. It was successful in one. Mild to moderate aortic incompetence was found in 2 patients (1.9%). It did no progress. Some degree of coronary artery obstruction was documented in 3 patients. Left ventricular systolic function remained whithin normal limits in all. One patient died as a result to a left coronary artery kinking, clearly shown on the previous angiogram. 

Conclusions:

The short and mid-term evolution after the arterial switch operation for TGA is excellent with a survival rate of 99% up to 11 years of follow-up. Ninety nine percent of survivors remain in NYHA functional class I, keep on sinus rhythm and have a normal left ventricular systolic function. The most frequent complication was supravalvular pulmonary stenosis (24.7%), severe in only 8.9% and required treatment. Aortic incompetence was not important and did not progress. The only cause of late mortality was coronary artery obstruction.