Circulation, Vol 88, 615-620, Copyright © 1993 by American Heart Association
M Hourihan, SD Colan, G Wernovsky, U Maheswari, JE Mayer Jr and SP Sanders
BACKGROUND. We investigated the size and growth potential of the neoaortic
root and aortic anastomosis after the arterial switch operation (ASO) for
D-transposition of the great arteries (D-TGA) performed in infants.
Circumferential suture lines connecting the great arteries and extensive
surgery on the arterial roots to transplant the coronary arteries are
essential parts of the ASO. However, little is known about the growth of
the aortic anastomosis, the neoaortic root, and the neoaortic annulus after
the ASO performed in infancy. METHODS AND RESULTS. Serial echocardiograms
on 50 patients with D-TGA who underwent ASO in infancy at our institution
were reviewed, and the size of the aortic anastomosis, the neoaortic root,
and the neoaortic annulus were compared with similar structures in a group
of 312 control subjects. Before surgery, the native pulmonary root (future
neoaortic root) was 1.59 SD larger (P < .001) and the native pulmonary
annulus (future neoaortic annulus) was 1.4 SD larger (P < .001) in
infants with D-TGA than the aortic root and annulus of control patients. At
a mean of 22 months (12 months to 6 1/2 years) after surgery, the diameter
of the aorta at the anastomosis was 0.45 SD smaller than the ascending
aorta of control subjects (P < .001). The neoaortic root was 2.9 SD
larger (P < .001) and the neoaortic annulus was 1.6 SD larger (P <
.001) than the comparable structures in the control population. Most
important, growth of the aortic anastomosis was commensurate with somatic
growth, but the dilation of the neoaortic root appeared to be progressive
over time. The neoaortic root was significantly more dilated in patients
with a history of pulmonary artery banding (P < .001) and in patients
with neoaortic regurgitation (P < .001). The presence of a ventricular
septal defect was not significantly related to postoperative neoaortic root
size. CONCLUSIONS. This study underlies the importance of continued
acquisition and examination of the data regarding the long-term outcome of
the arterial switch operation performed in infancy.
ARTICLES
Growth of the aortic anastomosis, annulus, and root after the arterial switch procedure performed in infancy
Department of Cardiology, Children's Hospital, Boston, MA 02115.
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