Naruhito Watanabe, MD, Richard D. Mainwaring, MD, Sergio A

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Presentation transcript:

Left Ventricular Retraining and Late Arterial Switch for d-Transposition of the Great Arteries Naruhito Watanabe, MD, Richard D. Mainwaring, MD, Sergio A. Carrillo, MD, George K. Lui, MD, V. Mohan Reddy, MD, Frank L. Hanley, MD The Annals of Thoracic Surgery Volume 99, Issue 5, Pages 1655-1663 (May 2015) DOI: 10.1016/j.athoracsur.2014.12.084 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Bar graph demonstrating the age at enrollment into the left ventricular retraining and late arterial switch program. The Annals of Thoracic Surgery 2015 99, 1655-1663DOI: (10.1016/j.athoracsur.2014.12.084) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Flow diagram for the 32 patients with d-transposition who were enrolled in the left ventricular retraining and late arterial switch operation (ASO) program. (PAB = pulmonary artery banding.) The Annals of Thoracic Surgery 2015 99, 1655-1663DOI: (10.1016/j.athoracsur.2014.12.084) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Bar graph demonstrating the number of pulmonary artery bandings per patient with subsequent outcome. (ASO = arterial switch operation.) The Annals of Thoracic Surgery 2015 99, 1655-1663DOI: (10.1016/j.athoracsur.2014.12.084) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Graph demonstrating the age at the time of entrance into the left ventricular retraining and late arterial switch program. The mortalities are denoted by a shaded symbol. (PAB = pulmonary artery banding.) The Annals of Thoracic Surgery 2015 99, 1655-1663DOI: (10.1016/j.athoracsur.2014.12.084) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Actuarial analysis of the 32 patients who were enrolled in the left ventricular retraining and late arterial switch program. (ASO = arterial switch operation; PAB = pulmonary artery banding.) The Annals of Thoracic Surgery 2015 99, 1655-1663DOI: (10.1016/j.athoracsur.2014.12.084) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 (A) Illustration depicting the main pulmonary artery (MPA), pulmonary band, and branch pulmonary arteries (PA). At end-systole, the left ventricular (LV) pressure is 120 mm Hg, the pressure in the “reservoir” between the pulmonary valve and band is 120 mm Hg, and the pressure beyond the band in the branch pulmonary arteries is 25 mm Hg. (B) Illustration of the banded pulmonary trunk during diastole. The reservoir, which was fully pressurized during systole, now has the opportunity to decompress into the branch pulmonary arteries. The result is the pressure in the reservoir is reduced to 15 mm Hg, equal to the pulmonary artery diastolic pressure. (C) Illustration of the banded pulmonary trunk in early systole. The pressure that the left ventricle must generate (15 mm Hg) to reopen the pulmonary valve is equivalent to the pulmonary artery diastolic pressure. We hypothesize that the low early systolic pressure in the LV is an imperfect method of training and may account for the diastolic dysfunction observed in some patients after late arterial switch. The Annals of Thoracic Surgery 2015 99, 1655-1663DOI: (10.1016/j.athoracsur.2014.12.084) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions