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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2000 April;41(2):233-9

lingua: Inglese

Late complications and quality of life after atrial correction of transposition of the great arteries in 12 to 18 year follow-up

Hucín B., Voriskova M., Hruda J., Marek J., Janousek J., Reich O., Skovranek J.

From the Kardiocentrum University Hospital Motol, Prague, Czech Republic


Background. Most ado­les­cents and ­young ­adults ­born ­with trans­po­si­tion of the ­great arter­ies and sur­vivors of Mustard oper­a­tion are ­alive ­today and are lead­ing ordi­nary ­lives. How far is the qual­ity of ­their ­life influ­enced by resid­u­al find­ings?
Methods. We ­have ana­lysed the old­est ­group of 177 chil­dren oper­at­ed on ­with the Mustard pro­ce­dure dur­ing 1979-1984 ­from our ­total expe­ri­ence of 609 cor­rec­tions of trans­po­si­tion of the ­great arter­ies ­until 1996. In the ­long-­term fol­low-up 12 to 18 ­years ­after Mustard oper­a­tion the clin­i­cal inves­ti­ga­tion, 24 ­hours ECG Holter mon­i­tor­ing, 2D and ­colour ­flow Doppler ech­o­car­di­og­ra­phy, radio­nu­clide angio­car­di­og­ra­phy and exer­cise test­ing ­were per­formed.
Results. Basic ­sinus ­rhythm had 61% of 137 sur­vi­vors, ­sinus ­node dys­func­tion had 51%. All but 4 ­patients ­needed no anti­ar­rhyth­mic ther­a­py. There ­were 10 sud­den ­deaths. Severe tri­cus­pid ­valve regur­gi­ta­tion devel­oped in 15.9% of chil­dren, and ­decreased to 6% ­after inten­sive med­i­cal treat­ment. The ­right ven­tric­u­lar sys­tol­ic dys­func­tion was ­found on radio­nu­clide ven­tric­u­log­ra­phy in 8% of chil­dren ­after sur­gery. The left ven­tric­u­lar ejec­tion frac­tion was sub­nor­mal in 10% and ­left ven­tric­u­lar dia­stol­ic func­tion ­expressed by rap­id fill­ing frac­tion was sub­nor­mal in 80% of ­patients and may ­cause inabil­ity to ­increase car­diac out­put at exer­cise The obstruc­tion of ­caval ­veins was ­found in 9%. There ­were neu­ro­log­i­cal com­pli­ca­tions in 13.3% (10% ­already pre­op­er­a­tive­ly) but ­severe ­brain dam­age was ­found in 4.4% ­only.
Conclusions. Exer­cise tol­er­ance ­with the max­i­mum oxy­gen con­sump­tion ­over 30 ml/kg/min in 96% of inves­ti­gat­ed chil­dren sug­gests the ­good abil­ity and ­full effi­cien­cy for rec­re­a­tion ­sports. Most sur­vi­vors (84%) are report­ed to ­lead ordi­nary ­lives and func­tion in ­NYHA ­class I.

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