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ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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REVIEW ARTICLES  CARDIAC PAPERS


The Journal of Cardiovascular Surgery 1999 Agosto;40(4):517-22

lingua: Inglese

Midterm ­results of the neo­na­tal arte­ri­al ­switch oper­a­tion. A ­review

Massin M. M.

From the Division of Pediatric Cardiology University of Liège, Belgium


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Complete trans­po­si­tion of the ­great arter­ies is a rel­a­tively com­mon anom­a­ly, ­which com­pris­es 5 to 7% of all instanc­es of car­diac mal­for­ma­tions. Given the decreas­ing mor­tal­ity ­rates asso­ciat­ed ­with a neo­na­tal arte­ri­al ­switch oper­a­tion and the unac­cept­able mor­bid­ity asso­ciat­ed ­with atri­al baf­fle oper­a­tions, it is rea­son­able to ­accept ­this oper­a­tion as the pro­ce­dure of ­choice for the treat­ment of the com­plete trans­po­si­tion of the ­great arter­ies. It rep­re­sents a ­major improve­ment ­since it ­does not intro­duce any addi­tion­al intra­car­diac anom­a­ly, ­restores the ­left ven­tri­cle to its nat­u­ral system­ic func­tion, and main­tains the ­sinus ­node func­tion. Long-­term sur­vi­val ­exceeds 90%. Midterm gen­er­al ­health stat­us is encour­ag­ing. To ­date, ­there ­have ­been lim­it­ed ­long-­term fol­low-up stud­ies ­after a neo­na­tal arte­ri­al ­switch oper­a­tion, ­although the inter­me­di­ate ­data are prom­is­ing. It ­will be nec­es­sary to deter­mine wheth­er the the­or­ized ben­e­fits of the ana­tom­ic ­repair are real­ized, ­since expe­ri­ence is lim­it­ed to the ­last 15 ­years. Translocation of the cor­o­nary arter­ies ­remains one of the ­most dif­fi­cult ­aspects of the oper­a­tion and ­late mor­tal­ity ­appears to coin­cide ­with cor­o­nary ­artery ­events ­with sud­den ­death sec­on­dary to ­acute myo­car­dial infarc­tion ­being report­ed in 1-2% of hos­pi­tal sur­vi­vors. Supravalvar pul­mo­nary sten­o­sis, neo­aor­tic ­root dila­tion and val­var regur­gi­ta­tion, bron­cho­pul­mo­nary col­lat­er­al arter­ies, cor­o­nary insuf­fi­cien­cy, and myo­car­dial per­fu­sion abnor­mal­ities are oth­er spe­cif­ic are­as ­which ­require ­close obser­va­tion and fur­ther inves­ti­ga­tion.

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