Faculty Collaboration Database

Enhanced left ventricular training in corrected transposition of the great arteries by increasing the preload. Eur J Cardiothorac Surg 2016 Jun;49(6):1571-6

Date

11/29/2015

Pubmed ID

26613669

DOI

10.1093/ejcts/ezv416

Scopus ID

2-s2.0-84973367391 (requires institutional sign-in at Scopus site)   19 Citations

Abstract

OBJECTIVES: Patients with congenitally corrected transposition of the great arteries (ccTGA) without ventricular septal defect or left ventricular outflow tract obstruction need training of the morphological left ventricle (mLV) to undergo a double switch operation (DS) (atrial plus arterial switch). Establishing a sufficient gradient by pulmonary artery banding (PAB) is difficult and multiple re-pulmonary artery bandings (re-PABs) may be necessary to achieve the required physiology. We evaluate a new approach, consisting of a loose PAB in combination with an artificial atrial septal defect (aASD) to not only increase afterload but to dynamically enhance preload as well, in terms of the effectiveness of training of the mLV and the subsequent functional outcome after a DS.

METHODS: Six consecutive patients under 6 years of age with ccTGA, who were eligible for anatomical correction, underwent enhanced left ventricular training (eLVT). Four of these patients had failed to reach sufficient mLV pressure by PAB only.

RESULTS: Required systemic pressures in the mLV were achieved after a mean of 1.2 years of eLVT with no further re-PAB necessary in any patient. All patients underwent a successful DS with an uneventful postoperative period. At a mean follow-up period of 1.9 (range 0.4-3.8) years, stable LV cardiac function was observed in all patients.

CONCLUSIONS: The eLVT provides additional training of the mLV to bring patients to a DS. Even in situations when isolated conventional PAB is not effective enough, the novel combination of pressure and volume loading may help with LV retraining and reduce the need for sequential pulmonary band tightening.

Author List

Zartner PA, Schneider MB, Asfour B, Hraška V

Author

Viktor Hraska MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Blood Pressure
Child, Preschool
Constriction
Echocardiography, Three-Dimensional
Female
Follow-Up Studies
Heart Septum
Heart Ventricles
Humans
Infant
Magnetic Resonance Imaging
Male
Pulmonary Artery
Reoperation
Transposition of Great Vessels
Treatment Outcome
Ventricular Function, Left