Echocardiographic Follow-up after Arterial Switch Operation for Transposition of the Great Arteries

Han, Sung Sae; Jung, Tae Eun; Lee, Dong Hyup; Oh, Jung Hun; Lee, Jung Cheul; Lee, Jang Hoon; Lee, Yeung Hwan

Abstract

BACKGROUND: To evaluate the efficacy of arterial switch operation for transposition of great arteries, serial echocardiographic studies were performed in 8 patients who underwent the surgery between 1989 and 1998 at Dept. of Thoracic & Cardiovascular Surgery, Yeungnam University Hospital in Daegu City, Korea. MATERIAL AND METHOD: Follow-up period ranged from 6 months to 11 years(average of 4.1 years). Body weight ranged from 2.6kg to 4.8kg, with average of 3.6kg. 5 of 8 patients were preoperatively diagnosed as TGA+VSD, and 3 as TGA+IVS. LV function was evaluated by the measurement of LV shortening fraction, LVSTI, and LVEF. RVSTI was also measured. Postoperative function of valve and growth of great vessels were analyzed by the measurement of PSPGV, valvular regurgitation, LA/AO ratio, root dimension of aorta and pulmonary artery, comparing with the age matched controls, respectively. RESULT: LVEF had an average of 65.0+/-9.03% which is tended to increase serially. LVAOPG had an average of 15.9mmHg. RVPAPG, 27.5mmHg. From the measurement of aortic root dimension of 6 patients at end-systole, aortic root growth was assumed to increase more than the mean value of normal growth. PA root dimension at end-systole showed a similar growth progress when compared with age matched normal controls. Postoperative pulmonic valve regurgitation was noted in 5 of total 8 patients, in which 1 patient who showed grade 2 and 4 showed below grade 1. AR, in 6 patients and all grade 1. Except 1 patient, all the valvular regurgitations were below grade 1, which was presumed to be clinically insignificant.
CONCLUSION
LV function after arterial switch operation was maintained relatively well. Mild neoaortic stenosis was noted. Neopulmonary stenosis and regurgitation were less than moderate degree and surgical correction was not deemed to be necessary. Growth progress of aortic root was above normal than controls and PA root growth was similar to the normal controls, postoperatively. However, further change and refinement of surgical technique will decrease the incidence of neopulmonary stenosis and regurgitation.