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Senning operation for correction of the transposition of the great arteries, results, long-term outcome and quality of life  [PDF]
Miguel Angel Maluf
World Journal of Cardiovascular Diseases (WJCD) , 2012, DOI: 10.4236/wjcd.2012.23036
Abstract: Objective: Long-term results after the Senning operation for transposition of the great arteries are little known. Sinus node dysfunction and systemic ventricular dysfunction are crucial in patient survival. We evaluated the results, long term outcome and quality of life in a group of 39 patients. Methods: The study was a retrospective analysis, of 39 (39/40 = 97.5%) surgical surviving patients, submitted to Senning operation, with a mean follow-up time of 14.7 +/– 3.1 years. Electrocardiogram, echocardiogram, and chest radiograph series were performed every 6 months. Thirty six patients of this series underwent Holter study and ergometric test, to evaluate the physical capacity. Three patients living overseas were excluded. Results: There was only one late death (1/39) (late mortality = 2.5%): a 16 year-old patient had a no cardiac death. The actuarial survival was 95.0% (38/40) (simple or with little VSD, TGA). The probability of staying in sinus rhythm, in 39 surviving patients was 77.1% (30) or normal right ventricular function was 76.5% (29), 10 to 20 years after operation. The incidence of sinus node and right ventricular dysfunction increased gradually over time. No re-operations and pacemaker implantation, was performed. Functional class: I = 30 (85.7%) cases and functional class II = 5 (14.3%) cases. Conclusions: Patients with simple TGA submitted to Senning procedure in our experience, presented during late follow-up: 1—Low incidence of right ventricular dysfunction and active arrhythmias; 2—Low mortality and no sudden death recorded; 3—Good quality of life and 4—Satisfactory surgical results (free of re-operation or definitive pacemaker implantation).
Anestesia en la transposición de los grandes vasos ANESTHESIA IN THE TRANSPOSITION OF THE GREAT VESSELS
Lincoln de la Parte Pérez
Revista Cubana de Pediatr?-a , 2005,
Abstract: La transposición de los grandes vasos es una cardiopatía compleja que se acompa a de una elevada mortalidad. Se conoce que el 45 % de los pacientes fallece durante el primer mes de vida y alrededor del 90 % antes del a o. Las principales causas de la muerte son la hipoxia y la insuficiencia cardíaca. El desarrollo de las especialidades que trabajan en cirugía cardiovascular pediátrica ha permitido aumentar la supervivencia de estos ni os, especialmente con el uso de prostaglandinas para mantener el ductus permeable, la técnica de Raskind-Miller ( septostomía de balón) y una tendencia cada vez mayor a la corrección anatómica temprana (operación de Jatene) en lugar de los clásicos procedimientos paliativos y las técnicas de corrección fisiológica de Senning y Mustard . Se presenta una revisión bibliográfica sobre los factores a tener en cuenta en el manejo anestésico de estos pacientes. The transposition of the great vessels is a complex heart disease accompanied of a high mortality. It is known that 45 % of the patients die during the first month of life and at about 90 % do it before being one year old. The main causes of death are hypoxia and heart failure. The development of the specialties working in pediatric cardiovascular surgery has allowed to increase the survival of these children, specially with the use of prostaglandins to maintain the ductus permeable, the Raskind-Miller's technique (balloon septostomy), and an increasing trend towards an early anatomical correction (Jatene's operation) to replace the classical palliative procedures and Senning and Mustartd's techniques of physiological correction. A bibliographic review of the factors to be taken into account in the anesthetic management of these patients is presented.
Serial exercise testing in children, adolescents and young adults with Senning repair for transposition of the great arteries  [cached]
Buys Roselien,Budts Werner,Reybrouck Tony,Gewillig Marc
BMC Cardiovascular Disorders , 2012, DOI: 10.1186/1471-2261-12-88
Abstract: Background Patients with Senning repair for complete transposition of the great arteries (d-TGA) show an impaired exercise tolerance. Our aim was to investigate changes in exercise capacity in children, adolescents and adults with Senning operation. Methods Peak oxygen uptake (peak VO2), oxygen pulse and heart rate were assessed by cardiopulmonary exercise tests (CPET) and compared to normal values. Rates of change were calculated by linear regression analysis. Right ventricular (RV) function was assessed by echocardiography. Results Thirty-four patients (22 male) performed 3.5 (range 3–6) CPET with an interval of ≥ 6 months. Mean age at first assessment was 16.4 ± 4.27 years. Follow-up period averaged 6.8 ± 2 years. Exercise capacity was reduced (p<0.0005) and the decline of peak VO2 ( 1.3 ± 3.7 %/year; p=0.015) and peak oxygen pulse ( 1.4 ± 3.0 %/year; p=0.011) was larger than normal, especially before adulthood and in female patients (p<0.01). During adulthood, RV contractility changes were significantly correlated with the decline of peak oxygen pulse (r= 0.504; p=0.047). Conclusions In patients with Senning operation for d-TGA, peak VO2 and peak oxygen pulse decrease faster with age compared to healthy controls. This decline is most obvious during childhood and adolescence, and suggests the inability to increase stroke volume to the same extent as healthy peers during growth. Peak VO2 and peak oxygen pulse remain relatively stable during early adulthood. However, when RV contractility decreases, a faster decline in peak oxygen pulse is observed.
Congenitally corrected transposition of great vessels in fetus. A study case presentation.
Carlos García Guevara,Elsa Fleitas Ruisanchez,Carlos García Morejón,Andrés Savío Benavides
Revista Cubana de Cardiología y Cirugía Cardiovascular , 2011,
Abstract: The congenitally corrected transposition refers to a malformation in which the atrial andventricular chambers present discordant connections, being also discordant the ventricularchambers with the originated from each of them vessels. It is presented a case with aforementioned characteristics, diagnosed by the second quarter of pregnancy, which at momentof birth presented a rhythm disorder. We propose to report the current case, evidencing theimportance of adequate interpretation of four chambers, left ventricle short axis and threevessels echocardiographic views in the prenatal diagnosis of congenital cardiopathies.
Accessory mitral valve tissue causing severe left ventricular outflow tract obstruction in a post-Senning patient with transposition of the great arteries
Prashanth Panduranga,Thomas Eapen,Salim Al-Maskari,Abdullah Al-Farqani
Heart International , 2011, DOI: 10.4081/hi.2011.e6
Abstract: Accessory mitral valve tissue is a rare congenital anomaly associated with congenital cardiac defects and is usually detected in the first decade of life. We describe the case of an 18-year old post-Senning asymptomatic patient who was found to have accessory mitral valve tissue on transthoracic echocardiography producing severe left ventricular outflow tract obstruction.
Features of localization coronary arterial orifices and angles of origin their proximal segments in usually formed hearts and with transposition of the great vessels  [PDF]
Malov A.E.
Морфолог?я , 2011,
Abstract: The work purpose was revealing of features of localization coronary arterial orifices, angles of origin and acourse of their proximal segments in usually formed hearts and with transposition of the great vessels. Research is executedon 31 specimens of usually formed hearts and 31 specimens with transposition of the great vessels. For the estimation ofposition the orifices in aortic sinuses and orientation of a course of proximal segments of coronary arteries the morphologicalresearches was carried out. For the purpose of carrying out of the statistical processing, the obtained data has been presentedon schematic images. As a result of research statistically authentic differences in localization distribution coronary arterialorifices on a vertical axis are established at a transposition of the great vessels, in comparison with usually formed hearts.Peculiarities of an arrangement orifices with acute angles of origin their proximal segments of coronary arteries and themintramural course are established.
Anatomical reorganization of walls ventricles hearts of children in the place of arise muscles capillaries at the full form of the transposition of the great vessels  [PDF]
Malov A.E.,Vasilev V.A.
Морфолог?я , 2010,
Abstract: For the purpose of the definition of the features of anatomic reorganization of anterior ventricular heart walls inthe place of arise of papillary muscles at children with the full form of the transposition of the great vessels 31 specimenswith the given pathology from a birth till 11 months and 31 specimens of usually formed hearts of the same age group havebeen investigated. The distinguish features of abnormal hearts were: atrial and ventricular septal defects, patent ductus arteriosus.For reception of quantitative parameters of the object of the research - thickness of forward walls ventricles made themeasurement. The statistical analysis of the received data depending on age, type and quantity of communications is made.At a combination of a transposition with ventricular septal defect the thickening of right ventricular walls in the place of ariseof papillary muscles more often came to light. The transposition was accompanied by atrial septal defect, thinning of a leftventricular wall after 1 month was established. The transposition with patent ductus arteriosus and septal defects characterizedby thickening of wall of the right ventricle since 3 week. The combination of the transposition with ventricular and atrialseptal defects leads to the thickening of the wall of both ventricles.
Follow-up of our patients with transposition of the great arteries and arterial switch operation; comparison of simple and complex transposition cases  [cached]
Osman Akdeniz,Canan Ayabakan,Uygar Y?rüker,Kür?ad Tokel
Anadolu Kardiyoloji Dergisi , 2011,
Abstract: Objective: 1. Follow-up data of patients with simple transposition of great arteries (TGA) and TGA with ventricular septal defect (VSD), who had arterial switch operation (ASO) are compared. 2. Factors affecting mortality and morbidity after ASO are described.Methods: Seventy-six patients, who had an ASO between April 2007 and August 2010 were studied retrospectively. The patients with intact ventricular septum (IVS) (n=36) were in Group1, and those with VSD (n=40) in Group 2. The pre and postoperative clinical and echocardiographic variables and intensive care unit (ICU) outcomes were compared among groups using Mann-Whitney U, Pearson correlation and logistic regression tests.Results: The mean age at operation was 44.1 days, weight was 3.6±0.98 kg. Patients were followed for 15.5±11.21 months. The aortic cross-clamp (AoCC) and cardiopulmonary bypass (CPB) times were higher in patients with VSD (p=0.001, p=0.004). Patients in Group 1 had longer inotropic agent infusion (p=0.001). Length of stay in ICU was similar in two groups (p>0.05). There was no correlation between the length of stay in ICU and age, weight, CPB time, AoCC time. Aortic regurgitation was more frequent in Group 2 (p=0.02). During follow-up, 12 patients died (15.7%), and 8 patients had a revision operation (10.5%) (diaphragmatic plication in 4, pulmonary artery reconstruction in 1, recoarctation operation in 3 patients). Mortality was similar in groups (p>0.05).Conclusion: Arterial switch operation provides anatomical correction in TGA. Appropriate timing and good perioperative planning facilitates low morbidity and mortality in patients with VSD as in patients with simple TGA.
Opera??o de Senning com a utiliza??o de tecidos do próprio paciente
CANêO, Luiz Fernando;LOUREN?O FILHO, Domingos D.;ROCHA E SILVA, Roberto;FRANCHI, Sonia M.;AFIUNE, Jorge Y.;AFIUNE, Cristina M. Camargo;MOCELIN, Amilcar O.;BARBERO-MARCIAL, Miguel;JATENE, Fabio B.;
Revista Brasileira de Cirurgia Cardiovascular , 1999, DOI: 10.1590/S0102-76381999000400004
Abstract: one of the main theoretical advantages of the original senning operation is the ability to avoid either biologic or synthetic patches for atrial septum augmentation or to enlarge pulmonary venous pathways. to accomplish this we have performed the senning procedure with some modifications that allow the operation to be completed without the use of heterologous tissue. twelve children, aged 5 months to 4 years (mean age: 20 months) with transposition of great arteries who had previous balloon atrial septostomy were submitted to the senning procedure. the following associated lesions were diagnosed: ventricular septal defect in 1 patient, valvular pulmonary stenosis in 1 and auricular juxtaposition in 1. the modified technique used for atrial septum augmentation was the use of open inverted left auricula in 5 cases, inverted auricula in 2 and in situ autologous pericardium for venous pathway enlargement in 5. the hospitalization was 10 to 24 days (mean = 15 days) and the post-operative period was 7 to 22 days (mean = 12 days). there were no in-hospital or late deaths during a mean follow-up period of 23 months (range 8 to 34 months). all patients had a good clinical outcome and their follow-up echocardiographic examinations showed no evidence of venous pathway obstruction. this modified senning operation can be performed without either biologic or synthetic patches for atrial septum augmentation or to enlarge pulmonary venous pathway. the use of autologous in situ tissues with potential for growth, retains the main theoretical advantage of the original technique.
Midterm results after arterial switch operation for transposition of the great arteries: a single centre experience  [cached]
Popov Aron Frederik,Tirilomis Theodor,Giesler Michael,Oguz Coskun Kasim
Journal of Cardiothoracic Surgery , 2012, DOI: 10.1186/1749-8090-7-83
Abstract: Background The arterial switch operation (ASO) has become the surgical approach of choice for d-transposition of the great arteries (d-TGA). There is, however an increased incidence of midterm and longterm adverse sequelae in some survivors. In order to evaluate operative risk and midterm outcome in this population, we reviewed patients who underwent ASO for TGA at our centre. Methods In this retrospective study 52 consecutive patients with TGA who underwent ASO between 04/1991 and 12/1999 were included. To analyze the predictors for mortality and adverse events (coronary stenoses, distortion of the pulmonary arteries, dilatation of the neoaortic root, and aortic regurgitation), a multivariate analysis was performed. The follow-up time was ranged from 1–10 years (mean 5 years, cumulative 260 patient-years). Results All over mortality rate was 15.4% and was only observed in the early postoperative period till 1994. The predictors for poor operative survival were low APGAR-score, older age at surgery, and necessity of associated surgical procedures. Late re-operations were necessary in 6 patients (13.6%) and included a pulmonary artery patch enlargement due to supravalvular stenosis (n = 3), coronary revascularisation due to coronary stenosis in a coronary anatomy type E, aortic valve replacement due to neoaortic valve regurgitation (n = 2), and patch-plasty of a pulmonary vein due to obstruction (n = 1). The dilatation of neoaortic root was not observed in the follow up. Conclusions ASO remains the procedure of choice for TGA with acceptable early and late outcome in terms of overall survival and freedom of reoperation. Although ASO is often complex and may be associated with morbidity, most patients survived without major complications even in a small centre.
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