dTGA/IVS

Dextro-transposition of the great arteries with an intact ventricular septum

DTGA ivs web-01

Clinical presentation spectrum

  • Unrestrictive atrial septum
  • Restrictive/intact atrial septum

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Preoperative considerations

Importance of feeding

Extubation?

Off PGE?  Overrated…

Day of surgery related to HLOS as interesting aside?

 

Operative considerations

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DTGA_Post.jpgAswitch.jpg

 

Important outcome papers

2002, Circulation – Coronary patterns and outcomes after ASO

2016, Ann Thor Surg – Outcomes in ASO with intramural coronaries

2014, JACC – Hot topics review of ASO*

2013, Circulation – Long-term outcomes following ASO – Boston

2013, Ann Thor Surg – Neoaortic root dilation following ASO

2009, Cong Heart Dis – PAB and ECMO in late presenters

2004, Circulation – Neoaortic root dilation following ASO

 

Technical papers

1978, Thorax – Yacoub coronary classification and transfer techniques

Historical perspectives

Although outcomes for dTGA/IVS are currently outstanding, it hasn’t always been so.  Many of the operations we use for other heart diseases were first pioneered for this heart defect.  Here’s a quick review.

The first approach was an atrial switch.  While this relieved cyanosis, it left the right ventricle as the systemic ventricle (pumping to the aorta) for the lifetime, caused atrial arrhythmias, and other problems.

1954, Surgery – Mustard for DTGA

1978, Ann Thor Surg – Outcomes after Mustard for dTGA – Boston

The second approach was an anatomic connection between the aorta and pulmonary artery, the modern day ‘DKS’ – Damus, Kaye and Stansel all described this operation for dTGA.

1975, Ann Thor Surg – Damus

1975, Ann Thor Surg – Stansel

The final approach was our current one, in which the great arteries are switched, including a transfer of the coronary arteries from the aortic root to the ‘neo-aortic’ root.’  Performing this operation in the newborn period was viewed with great skepticism at first, but Aldo Casteneda, John Mayer, and others at BCH proved that it could be done, and done well.

1975, Arq Bras Cardiol – Original Jatene operation

1984, Ann Thor Surg – First 14 neonatal ASOs – Boston

 

 

 

 

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