Frontiers in cardiovascular medicine · 2025
The landscape of management and outcome of children with congenitally corrected transposition of the great arteries: a single-center experience.
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Alahmed Yazeed Saleh, Jijeh Abdulraouf M Z, Alsaiad Abdulsalam M, Yelbuz T Mesud, Kabbani Mohamed S, Alghamdi Abdullah A, Alhabshan Fahad, Alibrahim Ibrahim J
Аннотация
OBJECTIVE: To compare the outcomes in patients with congenitally corrected transposition of the great arteries (ccTGA) who were offered different surgical management strategies.
DESIGN AND SETTINGS: We retrospectively included all patients from our center diagnosed with ccTGA between 2000 and 2021. The cohort was divided into four groups: (1) patients with systemic right ventricle; (2) patients with anatomic repair (in the form of an atrial and arterial switch or an atrial switch and Rastelli operation); (3) patients with a one-and-a-half ventricle repair (hemi-Mustard type) and bidirectional cavopulmonary connection and placement of a right ventricle to pulmonary artery conduit; and (4) patients with a single ventricle who were not suitable for biventricular repair.
RESULTS: The study included 42 patients with ccTGA. In 39 patients (93%), ccTGA was associated with other congenital heart defects. Group 1 (systemic right ventricle) comprised 16 patients (38%); seven of them underwent pulmonary artery banding, with a reduction in tricuspid valve regurgitation seen in four patients. Group 2 (anatomic group) and Group 3 (one-and-a-half ventricle group) each had three patients (7%). Group 4 (single-ventricle palliation) consisted of 17 patients (40%); 15 of them (88%) completed total cavopulmonary connection. Three early mortalities (7%) were recorded.
CONCLUSIONS: Patients who underwent anatomical repair (Rastelli-type) or a one-and-a-half ventricle repair (hemi-Mustard type) showed a good outcome with satisfactory biventricular function. Moreover, single-ventricle palliation showed excellent mid-term results in patients with ccTGA. PA banding may reduce tricuspid regurgitation in patients with ccTGA. A follow-up of our managed patients by an individualized plan demonstrated satisfactory outcomes.
DESIGN AND SETTINGS: We retrospectively included all patients from our center diagnosed with ccTGA between 2000 and 2021. The cohort was divided into four groups: (1) patients with systemic right ventricle; (2) patients with anatomic repair (in the form of an atrial and arterial switch or an atrial switch and Rastelli operation); (3) patients with a one-and-a-half ventricle repair (hemi-Mustard type) and bidirectional cavopulmonary connection and placement of a right ventricle to pulmonary artery conduit; and (4) patients with a single ventricle who were not suitable for biventricular repair.
RESULTS: The study included 42 patients with ccTGA. In 39 patients (93%), ccTGA was associated with other congenital heart defects. Group 1 (systemic right ventricle) comprised 16 patients (38%); seven of them underwent pulmonary artery banding, with a reduction in tricuspid valve regurgitation seen in four patients. Group 2 (anatomic group) and Group 3 (one-and-a-half ventricle group) each had three patients (7%). Group 4 (single-ventricle palliation) consisted of 17 patients (40%); 15 of them (88%) completed total cavopulmonary connection. Three early mortalities (7%) were recorded.
CONCLUSIONS: Patients who underwent anatomical repair (Rastelli-type) or a one-and-a-half ventricle repair (hemi-Mustard type) showed a good outcome with satisfactory biventricular function. Moreover, single-ventricle palliation showed excellent mid-term results in patients with ccTGA. PA banding may reduce tricuspid regurgitation in patients with ccTGA. A follow-up of our managed patients by an individualized plan demonstrated satisfactory outcomes.