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Cardiac Catheterization Interventions in the Right Ventricular Outflow Tract and Branch Pulmonary Arteries Following the Arterial Switch Operation

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Abstract

The arterial switch operation for d-transposition of the great arteries achieves anatomic repair but creates the potential for right ventricular outflow tract obstruction as a result of the LeCompte maneuver. The resultant right ventricular hypertension is generally well tolerated but a select group are referred for cardiac catheterization. The outcomes of these catheterizations have not been well described. The objective of this study was to describe the degree and nature of right ventricular outflow tract obstruction found during cardiac catheterization among patients following the arterial switch operation as well as determine the rate of intervention and assess the acute impact of any catheter intervention undertaken. We conducted a retrospective study of patients after arterial switch operation with the LeCompte maneuver and subsequent right heart catheterization. Descriptive statistics were reported, and paired sample t tests were used for analysis. 544 children had an arterial switch operation, of which 110 children (20%) had a cardiac catheterization procedure after surgery and 11% had a right heart catheterization. Of the right heart catheterizations, 90% had an intervention (balloon and/or stent). In the interventional group, the right ventricle to systemic pressure ratio decreased modestly, from 2/3 to half systemic, after balloon dilation and/or stent placement (p < 0.01). No serious complications were observed.

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Abbreviations

ASO:

Arterial switch operation

BAS:

Balloon atrial septostomy

d-TGA:

Dextro-transposition of the great arteries

DORV:

Double outlet right ventricle

IQR:

Interquartile range

LPA:

Left pulmonary artery

MPA:

Main pulmonary artery

MRI:

Magnetic resonance imaging

PA:

Pulmonary artery

RHC:

Right heart catheterization

RPA:

Right pulmonary artery

RV:

Right ventricle

RVOTO:

Right ventricular outflow tract obstruction

SVC:

Superior vena cava

VSD:

Ventricular septal defect

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Authors and Affiliations

  1. Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Michael N. Gritti, Ahmed Hassan & Audrey C. Marshall

  2. Division of Paediatric Cardiology, The Hospital for Sick Children, Toronto, ON, Canada

    Michael N. Gritti, Pedrom Farid, Ahmed Hassan & Audrey C. Marshall

  3. Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Pedrom Farid

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  1. Michael N. Gritti
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Contributions

MNG and ACM came up with the concept. MNG wrote the first draft of the manuscript. MNG, AH, and PF helped with the data collection. MNG, ACM, and PF did the data analysis. All authors reviewed and edited the manuscript and helped prepare figures.

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Correspondence to Michael N. Gritti.

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Gritti, M.N., Farid, P., Hassan, A. et al. Cardiac Catheterization Interventions in the Right Ventricular Outflow Tract and Branch Pulmonary Arteries Following the Arterial Switch Operation. Pediatr Cardiol (2024). https://doi.org/10.1007/s00246-024-03408-w

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