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- Title
Arteryel Switch Operasyonlarında Aortopulmoner Çap Uyumsuzluğunu Gidermek İçin Nonkoroner Sinüs Plikasyonu.
- Abstract
Background: Severe aortopulmonary diameter mismatch is a problem encountered during arterial switch operation. It may cause postoperative neoaortic valve insufficiency by disrupting the geometry of the sinotubular junction. In this study, we analyzed the surgical techniques and outcomes of aortopulmonary diameter mismatch. Materials and Methods: Patients who underwent surgical procedures to correct pulmonary artery/aortic diameter mismatch between December 2017 and May 2023 in our hospital were included in the study. Patients were divided into two groups as those who underwent noncoronary sinus plication and those who underwent other techniques. Pulmonary artery/aortic diameter mismatch was defined as a pulmonary artery diameter more than twice the diameter of the aorta at the sinotubular junction. Results: Aortopulmonary diameter mismatch was present in 23 (18.1%) of 127 patients who underwent arterial switch operation. Of the patients with aortopulmonary diameter mismatch, 15 (65.2%) underwent noncoronary sinus plication, 5 (21.7%) underwent dilatation through a longitudinal incision in the anterior aortic wall, 2 underwent tissue resection from the pulmonary artery, and 1 (4.4%) underwent dilatation with an autologous pericardial patch in the anterior aortic wall. Fifteen patients were male (p=0,371), median age was 14 days (p=0,825) and median weight was 3.3 kg (p=0,392). While 9 patients had simple TGA, transposition of the great arteries was associated with ventricular septal defect in 10 patients, Taussig-Bing anomaly in 4 patients and aortic arch pathology in 4 patients. Two patients died due to left ventricular dysfunction and one patient died due to sepsis. There was no significant difference in perioperative data between the groups. The rate of mild neoaortic valve regurgitation at follow-up was 33.3% (n=5) in patients with noncoronary sinus plication and 37.5% (n=3) in patients with other techniques (p=0,842). Neoaortic valve stenosis or moderate/severe neoaortic valve insufficiency was not detected in any patient. Conclusions: Surgical techniques used to correct aortopulmonary diameter mismatch have similar results. Noncoronary sinus plication is a simple, low-risk and easy-to-perform procedure to correct aortopulmonary diameter mismatch in arterial switch operations. Using this technique, the asymmetry between the aorta and pulmonary artery can be eliminated and a m ore natural anatomy can be created.
- Subjects
CONGENITAL heart disease; PULMONARY artery; TREATMENT effectiveness; SURGICAL complications; TRANSPOSITION of great vessels; MITRAL valve insufficiency; REOPERATION; SEPSIS; VENTRICULAR septal defects; CARDIAC surgery; LEFT ventricular dysfunction
- Publication
Journal of Harran University Medical Faculty / Harran Üniversitesi Tıp Fakültesi Dergisi, 2024, Vol 21, Issue 1, p67
- ISSN
1304-9623
- Publication type
Article
- DOI
10.35440/hutfd.1330996