HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Giovanni Battista Luciani Vaughn A. Starnes Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Luciani, G. B. Articles by Starnes, V. A. Search for Related Content PubMed PubMed Citation Articles by Luciani, G. B. Articles by Starnes, V. A. Related Collections Related Article

Ann Thorac Surg 1996;61:800-804
© 1996 The Society of Thoracic Surgeons

---

Original Articles: Cardiovascular

Surgical Repair of Transposition of the Great Arteries in Neonates With Persistent Pulmonary Hypertension

Divisions of Cardiothoracic Surgery and Cardiology, Childrens Hospital Los Angeles, and Departments of Surgery and Pediatrics, University of Southern California School of Medicine, Los Angeles, California

Accepted for publication October 11, 1995.

Background. Pulmonary hypertension due to persistent fetal circulation is rarely associated with transposition of the great arteries and intact ventricular septum. Previous attempts at management of affected neonates using prostaglandin E₁ and balloon atrial septotomy followed by surgical repair have been largely unsuccessful.

Methods. Between September 1992 and April 1995, 45 neonates underwent repair of transposition of the great arteries with the arterial switch operation. Two patients (4%) with transposition of the great arteries and intact ventricular septum presented with profound reversed differential desaturation and right-to-left shunting at the level of the ductus arteriosus after balloon atrial septotomy. A diagnosis of persistent pulmonary hypertension was established and both neonates entered an experimental management protocol using inhaled nitric oxide and rapid arterial switch operation.

Results. Preoperative hemodynamic stabilization was achieved in 1 patient using 40 parts per million of inhaled nitric oxide, whereas the other required in addition extracorporeal membrane oxygenation for severe biventricular dysfunction. Both underwent successful surgical repair 4 to 5 days after admission, but received postoperatively 1 week of inhaled nitric oxide therapy for persistent pulmonary hypertension. Follow-up echocardiography at 3 months showed good biventricular function and normal geometry of the ventricular septum, suggesting low pulmonary artery pressure, in both.

Conclusions. A management protocol using inhaled nitric oxide and extracorporeal membrane oxygenation followed by the arterial switch operation was successfully used in neonates with transposition of the great arteries, intact ventricular septum, and persistent pulmonary hypertension. Wider use of preoperative and postoperative inhaled nitric oxide may improve the surgical outcome of this difficult subset of patients.

Related Article

Invited Commentary

Gil Wernovsky
Ann. Thorac. Surg. 1996 61: 805. [Extract] [Full Text]

This article has been cited by other articles:

				M. T.R. Roofthooft, K. A. Bergman, T. W. Waterbolk, T. Ebels, B. Bartelds, and R. M.F. Berger Persistent Pulmonary Hypertension of the Newborn With Transposition of the Great Arteries Ann. Thorac. Surg., April 1, 2007; 83(4): 1446 - 1450. [Abstract] [Full Text] [PDF]

				S. Jaillard, E. Belli, T. Rakza, B. Larrue, E. Magnenant, C. Rey, and L. Storme Preoperative ECMO in Transposition of the Great Arteries With Persistent Pulmonary Hypertension Ann. Thorac. Surg., June 1, 2005; 79(6): 2155 - 2158. [Abstract] [Full Text] [PDF]

				A. Dodge-Khatami, A. Kadner, F. Berger, H. Dave, M. I. Turina, and R. Pretre In the Footsteps of Senning: Lessons Learned From Atrial Repair of Transposition of the Great Arteries Ann. Thorac. Surg., April 1, 2005; 79(4): 1433 - 1444. [Abstract] [Full Text] [PDF]

				R. Sharma, S. K. Choudhary, A. Bhan, R. Juneja, S. S. Kothari, A. Saxena, and P. Venugopal Left ventricle is better suited as pulmonary ventricle in simple transposition with severe pulmonary hypertension Ann. Thorac. Surg., November 1, 2002; 74(5): 1612 - 1615. [Abstract] [Full Text] [PDF]

				Y. V. Maeno, S. A. Kamenir, B. Sinclair, M. E. van der Velde, J. F. Smallhorn, and L. K. Hornberger Prenatal Features of Ductus Arteriosus Constriction and Restrictive Foramen Ovale in d-Transposition of the Great Arteries Circulation, March 9, 1999; 99(9): 1209 - 1214. [Abstract] [Full Text] [PDF]

				J. Soongswang, I. Adatia, C. Newman, J. F. Smallhorn, W. G. Williams, and R. M. Freedom Mortality in potential arterial switch candidates with transposition of the great arteries J. Am. Coll. Cardiol., September 1, 1998; 32(3): 753 - 757. [Abstract] [Full Text] [PDF]

				M. Aota, S.-i. Nomoto, S. Yamaki, and T. Ban Pulmonary Hypertension Caused by Medial Hypertrophy Associated With Aortic Stenosis and Preductal Coarctation Ann. Thorac. Surg., July 1, 1997; 64(1): 244 - 247. [Abstract] [Full Text]

				J. L. Myers Transposition of the Great Arteries Ann. Thorac. Surg., March 1, 1997; 63(3): 895 - 898. [Full Text]