Palliative Mustard operation for transposition of the great arteries: late results after 15-20 years

Atrial Switch Operation in a Late Presenter With d-Transposed Great Arteries, Juxtaposed Atrial Appendages, and Bilateral Superior Caval Veins

A 26-year-old patient with d-transposition of great arteries (d-TGA), bilateral superior vena cava, and juxtaposed atrial appendages underwent a successful atrial switch operation. It is extremely uncommon to encounter a previously unpalliated patient with d-TGA at this age. Unusual morphologic features in this patient necessitated technical modifications to successfully accomplish an atrial switch procedure.

Unidirectional valved patch closure of ventricular septal defect with arterial switch operation in a patient with d-transposition of great arteries with severe pulmonary hypertension

We report our experience with a five-year-old child with d-transposition of great arteries (d-TGA), ventricular septal defect (VSD), and severe pulmonary arterial hypertension (PAH). A fenestrated unidirectional-valved patch was used to close the VSD and a standard arterial witch operation (ASO) was performed. Difficulties in assessment of operability and the choice of procedures in such patients are briefly discussed.

Damus-Kaye-Stansel biventricular repair for transposition of the great arteries with pulmonary hypertension

An 18-year-old female with transposition of great arteries and severe pulmonary hypertension was successfully treated with Damus-Kaye-Stansel biventricular repair. Results of the 12-year follow-up showed satisfactory hemodynamics with the aortic valve staying closed throughout the cardiac cycle and without the pulmonary valve regurgitation.

Treatment options for transposition of the great arteries with ventricular septal defect complicated by pulmonary vascular obstructive disease

The arterial switch operation is the procedure of choice for patients with isolated transposition of the great arteries or those with associated atrial and/or ventricular septal defects. After the development of pulmonary arterial hypertension, the surgical options for patients with a late presentation include either retraining the left ventricle by pulmonary artery banding followed by an arterial switch operation or palliative atrial or arterial switch, with or without medical management of pulmonary hypertension. We present a case with D-transposition of the great arteries with ventricular septal defects and irreversible pulmonary arterial hypertension who improved after a palliative atrial switch operation.

Long-term prognosis of congenital heart defects: a systematic review

BACKGROUND

In the large and expanding population of adults with congenital heart disease, little is known about their long-term outcome. By means of a systematic literature search, we aimed to assess the quantity and quality of data on long-term survival and morbidity in adults with common congenital heart defects.

METHODS

All literature on MEDLINE from January 1980 to January 2007 was searched, using a broad range of keywords for atrial septal defect, ventricular septal defect, pulmonary stenosis, tetralogy of Fallot, aortic coarctation, and transposition of the great arteries. After study selection using pre-specified criteria and quality assessment, data were extracted and weighed according to number of patients. Pooled estimates were obtained.

RESULTS

We identified 322 articles. Selection yielded 35 articles comprising 7894 patients. Data on survival were mainly available up until 40 years of age. In this young population, survival varied from 87.4% in aortic coarctation to 99.6% in atrial septal defect. Data on morbidity were sparse. Based on these data, morbidity was substantial.

CONCLUSIONS

Until the age of 40 years, survival is decreased in patients with congenital heart defects, albeit most pronounced among patients with complex heart defects. Moreover, morbidity is considerable in all defects. Sufficient data on long-term survival and morbidity beyond the age of 40 years are lacking, yet crucial for optimal clinical care.

What Is the Perceived Quality of Life of Adults With Congenital Heart Disease and Does It Differ by Anomaly?

Adults with congenital heart disease (CHD) represent a growing population of patients thanks to the medical and surgical advances which enable at least 85% of children to survive to adulthood. These advances may create quality-of-life (QoL) issues not previously considered. The purpose of this cross-sectional study of 124 adults with CHD was to describe their QoL as a basis for providing appropriate information, counseling, and anticipatory guidance. Thirteen patients had single ventricle physiology (SVP), 43 had cyanotic lesions with 2 ventricle repairs, and 68 had acyanotic CHD. On the basis of Sickness Impact Profile (SIP) scores, individuals with SVP had worse QoL than did those with cyanotic lesions (with 2 ventricle repairs) and acyanotic anomalies (SIP = 9.98 vs 4.61 and 3.76). SIP scores were statistically significantly different between those with SVP and those with acyanotic anomalies (P = .02). For all groups, the areas of life most affected were work and sleep and rest. Participants with SVP saw themselves as having the poorest QoL.

Health status, functional abilities, and quality of life after the Mustard or Senning operation

BACKGROUND

Life expectancy of patients who underwent atrial switch operation for the transposition of the great arteries is relatively good. However, many patients are faced with residua and sequelae, which may hamper their functioning and quality of life. This multicenter study assessed the perceived health status, functional abilities, and quality of life in long-term survivors of the Mustard or Senning operation.

METHODS

A group of 89 patients (58% male) were selected from four tertiary care centers, consisting of 37 Mustard and 52 Senning operation patients. Perceived health status was measured using a linear analog scale. The educational level, employment status, New York Health Association classification, ability index, and Baecke questionnaire were used to evaluate functional abilities. Quality of life was assessed with a linear analog scale, the Satisfaction with Life Scale, and the Congenital Heart Disease-TNO/AZL Adult Quality of Life.

RESULTS

Patients reported good to very good perceived health, functional capacities, and quality of life. The responses of patients with complex transposition were equivalent to those of patients with simple transposition. The most dominant concerns reported by survivors of the Mustard and Senning operations were experiences about physical limitations and worries about a current or future job or income.

CONCLUSIONS

Long-term survivors after atrial inflow correction demonstrated favorable perceived health, functional status, and quality of life; these conditions were, to a large extent, comparable with the status of the general population. These outcome variables were not negatively affected by the complexity of the transposition.

Late results of palliative atrial switch for transposition, ventricular septal defect, and pulmonary vascular obstructive disease

BACKGROUND

Palliative atrial switch (PAS) procedures that reroute pulmonary and systemic venous drainage and leave a ventricular septal defect (VSD) open have been used in the treatment of deeply cyanotic patients who have severe pulmonary vascular obstructive disease (PVOD). Palliative atrial switch is beneficial for patients with transposition of the great arteries or other complex lesions with VSD who show higher arterial oxygen saturation in the pulmonary artery than in the aorta (transposition hemodynamics/unfavorable streaming). We reviewed the early and late results of PAS (Mustard, n = 25; Senning, n = 3) in patients at two institutions.

METHODS

Between April 1965 and March 2000, PAS was performed in 28 cyanotic patients (18 male, 10 female). Median age was 10 years (range, 1 to 27). Mean preoperative pulmonary arterial pressure was 68 mm Hg (range, 30 to 121 mm Hg). Mean systemic arterial oxygen saturation was 65% (range, 47% to 80%). The majority of patients (95%) were in New York Heart Association (NYHA) functional class III or IV preoperatively.

RESULTS

Overall early mortality was 21%; for patients after 1972 (n = 23), the early mortality was 8.7%. Mean follow-up was 8.3 years (maximum 20). Mean postoperative systemic arterial oxygen saturation was increased significantly to 88% (p < 0.0001). Late survival for early survivors at 5, 10, and 15 years respectively was 84% (59%, 97%), 64% (39%, 88%), and 54% (15%, 72%). The NYHA functional class was significantly improved; 94% of late survivors (n = 17) were in functional class I or II (p = 0.002).

CONCLUSIONS

The PAS operation significantly improves systemic arterial oxygen saturation and quality of life in selected patients with transposition hemodynamics, VSD, and severe PVOD.

Quality of life experienced by adults with congenital heart disease

Adults with congenital heart disease (CHD) represent a growing population of patients. Medical and surgical advances have increased the number of CHD adult survivors, which may create quality-of-life (QOL) issues not previously considered. Quality-of-life issues pertinent to this patient population involve health and life insurance acquisition, birth control, genetic counseling, pregnancy concerns, employment, and independent living arrangements. The purpose of this study was to describe the QOL of adults with CHD. The study used a prospective cross-sectional case-control design to examine QOL using the Sickness Impact Profile (SIP). The study participants were a sample of 124 adults with CHD from an outpatient cardiology clinic in a metropolitan university-affiliated teaching hospital in the Northeast and 124 matched healthy control subjects. Between the participants and the matched control subjects, there was a significant difference in the total mean SIP score, the physical and psychosocial dimension scores, and all the category scores (P < 0.05). The areas of life the adults with CHD reported as lacking in quality involved the categories of work (SIP of 11.1, moderate disability) and sleep and rest (SIP of 9.03, mild disability). The results of this study indicate that the SIP can be used for quantitative and subjective QOL assessment of adults with CHD. It is suggested that cardiac advanced practice nurses use the results of this study to develop appropriate information, counseling, and anticipatory guidance for this patient population.

Palliative arterial switch for complete transposition with ventricular septal defect

A 28-year-old female patient with complete transposition, ventricular septal defect and persistence of the arterial duct underwent a palliative arterial switch procedure in 1976 at 7 years of age. Therefore, she has survived for 22 years and lives a near normal life. She is married, has been counselled against pregnancy and has increasing cyanosis with the typical features of the Eisenmenger syndrome.