Title : Advances in pediatric and neonatal cardiac surgery
Abstract:
Background and Aim: Severe pulmonary arterial hypertension and pulmonary vascular disease develops in a majority of patients with Transposition of the great arteries and Ventricular septal defects not undergoing surgery in the first few months of life. This study aims to study the results of Palliative atrial switch operation with the Ventricular septal defects being left open in such patients and to evaluate the early and late clinical progression of pulmonary vascular disease following this procedure
Materials & Methods: The medical and surgical record of all patients undergoing an atrial switch procedure between 1990 and 2022 underwent the atrial procedure for d-Transposition of great arteries. Of these, twelve patients underwent palliative atrial switch procedure in which ventricular septal defect was left open due to raised pulmonary artery pressures and elevated pulmonary vascular resistance.
Results: Age of surgery ranged between 9 months- 20years. Preoperative echocardiography showed features of severe pulmonary arterial hypertension and right ventricular dysfunction in all patients. Cardiac catheterization showed mean pulmonary artery pressures ranging from 70mmHg-95mmHg. Following surgery, there was improvement in systemic saturation, activity and functional class in all patients. Mean hospital stay was 8-120days. There were no early deaths. Significant morbidity requiring prolonged intensive care unit stay was noted in four patients due to refractory pulmonary arterial hypertension, lower respiratory tract infection requiring tracheostomy and persistent pleural effusion in one patient. At a median follow-up of seven years (range 9 months to 13years), there was a mean increase in arterial oxygen saturation from 62.1% to 92.5% and hematocrit decreased from 49.4% to 36.3%. All patients were in Ross/NYHA class I-II. There were no late deaths or significant pulmonary or systemic venous obstruction or arrythmias.
Conclusion and Clinical significance: The palliative atrial switch procedure improved arterial oxygen saturation, improved activity and functional class, reduced polycythaemia, and provided a better quality of life in patients with d-Transposition of great arteries, Ventricular septal defects and severe pulmonary arterial hypertension.
