Excision of the Coronary Orifices in Arterial Switch Operation: “O” Like Obstructive and “U” Like Unobstructive?[*]

Abstract

Background: Stenoses of the neo-pulmonary artery (NPA) may complicate follow-up of the arterial switch operation (ASO). It is unknown whether the type of patch covering the coronary excision defects (“O”- or “U”-shaped) might influence this complication. Methods: Echocardiographically and invasively measured NPA pressure-gradients were evaluated retrospectively in 95 children after ASO. Median follow-up was 5.8 years. Defects had been covered with pericardial patches: O/O and U/U (left/right) 34 × each, and 27 × in mixed combinations. The frequency of NPA stenoses requiring re-interventions was registered. Results: Median of the peak instantaneous echocardiographic pressure gradient was 23 mmHg (interquartile range, IQR: 16 - 49, n = 34) in O/O, and 19 mmHg (IQR: 13 - 23, n = 34) in U/U; p < 0.034, t-test. Invasively measured gradients were 49 mmHg (IQR: 17 - 65, n = 12) in O/O, and 12 mmHg (IQR: 7‐21, n = 28) in U/U; p < 0.001. One child per O/O- and U/U-group underwent balloon angioplasty of the neo-pulmonary root. Five children of the O/O-group had to undergo repeat surgery, whereas only one child in the U/U-group required repeat surgery (p < 0.34). Conclusions: The preferential type of covering the NPA coronary excision sites in ASO should be U‐shaped.

Key words

Arterial switch operation - pulmonary stenosis - coronary excision

1 The paper was presented at the 32nd Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery Leipzig, February 23 - 26, 2003

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1 The paper was presented at the 32nd Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery Leipzig, February 23 - 26, 2003