Document Detail


Intraoperative coronary artery pulse Doppler patterns in patients with complete transposition of the great arteries undergoing the arterial switch operation.
MedLine Citation:
PMID:  18760127     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Arterial switch operation is standard repair for complete transposition of the great arteries (TGA). Coronary artery abnormalities are the most common cause of morbidity and mortality in the acute postoperative phase. This study was designed to determine whether coronary artery pulse Doppler flow patterns obtained by transesophageal echocardiography during the arterial switch operation are correlated with acute postoperative outcomes. METHODS: A retrospective review of all patients with TGA undergoing the arterial switch operation between 2004 and 2006 was performed. Intraoperative coronary artery pulse Doppler flow patterns were analyzed by 2 blinded investigators. Associations of coronary artery pulse Doppler flow patterns with clinical outcomes were sought using multivariable linear and logistic regression analysis. RESULTS: Sixty-three patients (48 male, gestational age 38 +/- 2 weeks, birth weight 3,514 +/- 613 g) were analyzed. Three patients needed mechanical support (2 died), 19 had delayed sternal closure, 17 had arrhythmias, and 9 had ST changes. The most common coronary artery pulse Doppler flow pattern consisted of a late systolic peak followed by low-velocity flow throughout diastole. A left main coronary artery (LMCA) velocity time integral >0.14 (P = .01) and an LMCA peak systolic velocity >0.6 cm/s (P = .05) were associated with need for surgical revision. CONCLUSION: Abnormalities in LMCA flow were associated with the need for surgical revision in patients with TGA undergoing the arterial switch operation. Normal coronary artery pulse Doppler flow patterns after the arterial switch operation consisted of a late systolic peak followed by low-velocity flow throughout diastole.
Authors:
Derek Wong; Fraser Golding; Lembie Hess; Christopher A Caldarone; Glen Van Arsdell; Cedric Manlhiot; Brian W McCrindle; Steve E S Miner; Lynne E Nield
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Publication Detail:
Type:  Journal Article     Date:  2008-07-24
Journal Detail:
Title:  American heart journal     Volume:  156     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-09-01     Completed Date:  2008-09-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  466-72     Citation Subset:  AIM; IM    
Affiliation:
Hospital for Sick Children, Labatt Heart Centre, University of Toronto, Toronto, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Blood Flow Velocity
Cardiac Surgical Procedures*
Child
Child, Preschool
Coronary Circulation
Coronary Vessels / physiopathology*,  ultrasonography
Diastole
Echocardiography, Doppler, Pulsed*
Echocardiography, Transesophageal*
Female
Humans
Intraoperative Period
Male
Middle Aged
Observer Variation
Retrospective Studies
Systole
Transposition of Great Vessels / physiopathology*,  surgery*,  ultrasonography
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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