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Ann Thorac Surg 2003;75:935-943
© 2003 The Society of Thoracic Surgeons

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Original article: cardiovascular

Long-term results of cardiac and general health status in children after neonatal arterial switch operation

Hedwig H. Hövels-Gürich, MD^a*, Marie-Christine Seghaye, MD^a, Qing Ma, MD^a, Maria Mikova^a, Ralf Minkenberg, Dipl Phys^b, Bruno J. Messmer, MD^c, Götz von Bernuth, MD^a

^a Department of Pediatric Cardiology, University Hospital, Aachen University of Technology, Aachen, Germany
^b Institute For Medical Research and Information Processing, Aachen, Germany
^c Department of Thoracic and Cardiovascular Surgery, University Hospital, Aachen University of Technology, Aachen, Germany

Accepted for publication September 5, 2002.

^* Address reprint requests to Dr Hövels-Gürich, Department of Pediatric Cardiology, University Hospital, Aachen University of Technology, Pauwelsstrasse 30, D-52057 Aachen, Germany.
e-mail: hhoevels-guerich{at}ukaachen.de

BACKGROUND: The purpose of this study was to assess cardiac and general health status 8 to 14 years after neonatal arterial switch operation for transposition of the great arteries.

METHODS: Sixty unselected children with intact ventricular septum (78.3%) or ventricular septal defect (21.7%) without or with aortic isthmic stenosis (5.1%) were examined 10.5 ± 1.6 (mean ± SD) years after neonatal switch and 5.3 ± 1.6 years after mid-term evaluation. Complete clinical examination, standard and 24-hour Holter electrocardiogram, M-mode, 2D-, Doppler, and color Doppler echocardiography were performed. Results were compared with normal values and to mid-term follow-up results.

RESULTS: Rates of reoperation after arterial switch operation and operation to correct concomitant coarctation were 3.3% and 5.1%, respectively. No patient needed medication, and 93.3% had no limitation of physical activity. All children had normal height and weight; 31.6% had abnormal thoracic configuration after median sternotomy. Most patients (91.7%) were in sinus rhythm. Incidence of complete right bundle branch block (10.0%) was unchanged, as was prevalence of ectopic activity (occasional atrial ectopy 20.0%, ventricular ectopy: occasional 21.7%; frequent 1.7%). Left ventricular dimensions and shortening fraction did not change over time. Diameters of neo-aortic valve annulus and neo-aortic root did not increase, and z-scores decreased between mid-term and present evaluation. Incidence of neo-aortic insufficiency was 13.3% and remained unchanged in comparison with the pre-examination value. Neo-aortic stenosis was not seen. Compared with mid-term follow-up, incidence (41.6%) and degree of supravalvular pulmonary stenosis increased.

CONCLUSIONS: Good cardiac results persist 10 years after neonatal arterial switch operation for transposition of the great arteries. Encouraging findings include preservation of left ventricular function, low incidence of rhythm disturbances, lack of further neo-aortic root dilatation, and unchanged incidence of neo-aortic insufficiency compared with mid-term follow-up. Increased incidence and degree of supravalvular pulmonary stenosis are of concern.

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