[Late complications following early childhood atrial switch operations for d-transposition of the great arteries. Incidence, diagnosis and therapy].

BACKGROUND AND

OBJECTIVE

The atrial switch operation in patients with transposition of the great arteries have been replaced by the arterial switch operation in the neonatal period. However, an increasing number of atrial switch survivors has now reached adulthood. This study was aimed at evaluating the incidence and patterns of typical late complications in order to describe diagnostic and therapeutic options.

PATIENTS AND

METHODS

We retrospectively analysed the data of 40 adolescent and adult patients, who had an atrial switch operation a mean of 17,9 years ago (23 Senning, 17 Mustard operations). The mean age of the patients is 19,3 years with 40 % females. The follow up time in our institution was 4,7 years.

RESULTS

The most frequent complications were cardiac rhythm disturbances (47,5 % loss of sinus rhythm, 22,5 % intermittent atrial flutter, 22,5 % junctional rhythm, 7,5 % paroxysmal supraventricular tachycardia, 17,5 % sick sinus syndrome, 5 % premature ventricular contractions), severe tricuspid regurgitation (15 %), severe right ventricular failure (5 %), baffle leaks (27,5 %), baffle obstructions (17,5 %), and pulmonary artery hypertension.

CONCLUSION

The data demonstrate that adult patients who underwent atrial switch operation in early childhood need long term follow-up to allow early recognition and treatment of late complications, even in asymptomatic patients.