Abstract:

Objective To assess the outcomes of primary arterial switch operation (ASO) in treatment of D-transposition of the great arteries (DTGA) with intact ventricular septum (IVS) in children older than 3 weeks, and explore the significance of helix ventricular myocardial band (HVMB) in the treatment of DTGA/IVS. Methods The clinical data of 54 children with DTGA/IVS aged between 3 weeks and 16 months (late ASO group) and 74 children with DTGA/IVS aged less than 3 weeks (early ASO group) were analysed. In late ASO group, children were subdivided into ventricular septal migration (VSM) group (n=20, ventricular septa were straight or skewed to the left) and ventricular septal normal (VSN) group (n=34, ventricular septa were normal in appearance). The surgical outcomes of ASO were evaluated. Results There was no significant difference in time of extracorporeal circulation, time of aortic clamping, time of ventilator application after operation, time of intensive care after operation, duration of hospitalization and mortality between late ASO group and early ASO group (P＞0.05). There was no significant difference in mortality between VSM group and VSN group (10.0% vs 8.8%, P＞0.05). Conclusion Primary ASO may be appropriate treatment for children with DTGA/IVS aged between 3 weeks and 16 months, and the normal appearance of ventricular septa plays an important role in the outcomes, which can be well explained by the theory of HVMB.

Key words: D-transposition of the great arteries, arterial switch operation, helix ventricular myocardial band, ventricular septal