Cognitive development of children following early repair of transposition of the great arteries using deep hypothermic circulatory arrest.

Twenty-eight children who underwent corrective cardiac surgery in early infancy had developmental evaluations to explore whether cardiopulmonary bypass perfusion variables are associated with later cognitive function. All had transposition of the great arteries repaired by the arterial switch operation using deep hypothermic circulatory arrest. The mean duration of deep hypothermic circulatory arrest was 64 +/- 10 minutes (mean +/- SD).

Results of the arterial switch operation in patients with transposition of the great arteries and abnormalities of the mitral valve or left ventricular outflow tract.

Between January 1983 and October 1989, 290 patients underwent an arterial switch operation for transposition of the great arteries; 30 (10.3%) of the patients had abnormalities of the left ventricular outflow tract or mitral valve, or both. These abnormalities included isolated pulmonary valve stenosis (n = 9), septal (dynamic) subpulmonary stenosis (n = 5), anatomic (fixed) subpulmonary stenosis (n = 7), abnormal mitral chordae attachments (n = 2) or a combination of abnormalities (n = 7).

Coronary artery pattern and outcome of arterial switch operation for transposition of the great arteries.

A successful outcome of an arterial switch operation (ASO) for dextro-transposition of the great arteries (D-TGA) depends in large part on the transfer of the coronary arteries to the neoaorta without distortion or narrowing. However, the origins and distribution of the coronary arteries are quite variable in D-TGA; therefore, the entire experience with ASO at the Children's Hospital in Boston was reviewed. From 1983 through November 1989, 314 patients underwent surgery for D-TGA with the intent to perform an ASO.

Results of the arterial switch operation for transposition of the great arteries with ventricular septal defect. Surgical considerations and midterm follow-up data.

Between January 1983 and December 1987, 62 patients underwent an arterial switch operation for transposition of the great arteries with ventricular septal defect or double outlet right or left ventricle. There were three hospital deaths (4.8%), and no deaths occurred in neonates (less than 1 month of age, n = 18).

Rapid, two-stage arterial switch for transposition of the great arteries and intact ventricular septum beyond the neonatal period.

Optimal management of dextrotransposition of the great arteries with intact ventricular septum is currently an arterial switch procedure performed in the first 2 weeks of life. However, a subgroup of patients presents for surgery beyond this time for reasons of sickness, size, or late referral. Experience with 11 such patients (mean age at first-stage procedure, 4.

Comparison of technetium-99m MIBI and thallium-201 chloride myocardial scintigraphy in infants.

Myocardial perfusion scintigraphy was performed with both 201Tl and a new six coordinate monocationic isonitrile complex of 99mTc, [99mTc]2-methoxyisobutylisonitrile (MIBI), on 11 infants who had undergone the arterial switch procedure for transposition of the great arteries. Unlike 201Tl which can show rapid and variable rates of washout from myocardium, 73% of the initial first-pass activity of the isonitrile complex in the myocardium remains 1 hr after intravenous administration. The images obtained with [99mTc]MIBI required a shorter recording time, entailed less radiation exposure to the patient, and were qualitatively at least as good as those obtained with 201Tl.

Transposition of the great arteries: the arterial switch operation.

Primary arterial switch operation in neonates for repair of transposition of the great arteries with an intact ventricular septum or with a ventricular septal defect has become the operation of choice in our institution. By now, the surgical risk has been decreased to approximately 2 per cent. Early in our experience, postoperative supravalvar pulmonary stenosis was the only late hemodynamic complication of significance.

Myocardial performance after arterial switch operation for transposition of the great arteries with intact ventricular septum.

Left ventricular dimensions, wall thickness, wall stress, and indexes of afterload, preload, contractility, and early diastolic function, as well as regional wall motion, were determined by echocardiographic methods in patients with transposition of the great vessels after arterial switch operation and in age-matched normal controls. In patients evaluated early after surgery, body surface area-adjusted left ventricular dimensions were smaller, and wall thickness was increased compared with controls. Ventricular performance (fractional shortening) was normal in most patients but was abnormally low in 10%.

Midterm results after the arterial switch operation for transposition of the great arteries with intact ventricular septum: clinical, hemodynamic, echocardiographic, and electrophysiologic data.

Although the short-term results of atrial level repair of transposition of the great arteries (TGA) are satisfactory, longer follow-up has disclosed a significant incidence of systemic right ventricular dysfunction and rhythm disturbances. The arterial switch operation (ASO) may represent a major improvement by restoring the left ventricle as the systemic ventricle and avoiding extensive atrial surgery. We have prospectively evaluated 49 consecutive survivors of ASO for TGA with intact ventricular septum (IVS) by clinical examination, echocardiography, cardiac catheterization, ambulatory electrocardiographic monitoring, and invasive electrophysiologic studies.

L-phenylalanine mustard-dianhydrogalactitol and hyponatremia.

The incidence of hyponatremia in 34 patients following administration of high-dose L-phenylalanine mustard (L-PAM) and dianhydrogalactitol (DAG) was determined. Two consecutive daily levels of 133 mEq/l or less were observed in 12 patients. These episodes coincided with the advent of diarrhea about 10-12 days after drug administration.