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Intensive care management of neonates with d-transposition of the great arteries and common arterial trunk

  • Pirouz Shamszad (a1), Ryan A. Moore (a1), Nancy Ghanayem (a2) and David S. Cooper (a1)

Although mortality rates for patients with d-transposition of the great arteries remain quite low, these patients have a unique circulation that requires careful management in the peri-operative period. Despite the improved mortality for patients with common arterial trunk, the course in the intensive care unit is remarkable for significant morbidity and utilisation of significant resources. Pre-operative patient management focuses on balancing competing circulations, pulmonary and systemic, which exist in parallel rather than in series, as in the normal circulation. Post-operative patient management in both lesions focuses on optimising systemic output, respiratory status, and mitigating the effects of cardiopulmonary bypass. In this article, we review pre- and post-operative intensive care management in neonates with d-transposition of the great arteries and common arterial trunk.

Corresponding author
Correspondence to: Dr D. S. Cooper, MD, MPH, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, 3333 Burnet Avenue, MLC 2003, Cincinnati, Ohio 45229, United States of America. Tel: 513 803 1801; Fax: 513 636 3952; E-mail:
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1. J Marek , V Tomek , J Skovranek , et al. Prenatal ultrasound screening of congenital heart disease in an unselected national population: a 21-year experience. Heart 2011; 97: 124130.

3. J Liebman , L Cullum , NB Belloc . Natural history of transposition of the great arteries. Anatomy and birth and death characteristics. Circulation 1969; 40: 237262.

5. TA Fricke , Y d'Udekem , M Richardson , et al. Outcomes of the arterial switch operation for transposition of the great arteries: 25 years of experience. Ann Thorac Surg 2012; 94: 139145.

7. S Oda , T Nakano , J Sugiura , et al. Twenty-eight years’ experience of arterial switch operation for transposition of the great arteries in a single institution. Eur J Cardiothorac Surg 2012; 42: 674–679.

9. S Masutani , M Seki , M Taketazu , H Senzaki . Successful management of the persistent pulmonary hypertension of the newborn with transposition of the great arteries by restricted patency of the ductus arteriosus: a simple and rational novel strategy. Pediatr Cardiol 2009; 30: 10031005.

10. L Hellstrom-Westas , K Hanseus , P Jogi , et al. Long-distance transports of newborn infants with congenital heart disease. Pediatr Cardiol 2001; 22: 380384.

11. A Oxenius , MI Hug , A Dodge-Khatami , et al. Do predictors exist for a successful withdrawal of preoperative prostaglandin E1 from neonates with d-transposition of the great arteries and intact ventricular septum? Pediatr Cardiol 2010; 31: 11981202.

12. RJ Butts , AR Ellis , SM Bradley , et al. Effect of prostaglandin duration on outcomes in transposition of the great arteries with intact ventricular septum. Congenit Heart Dis 2012; 7: 387391.

13. DS Lim , TJ Kulik , DW Kim , et al. Aminophylline for the prevention of apnea during prostaglandin E1 infusion. Pediatrics 2003; 112 (1 Pt 1): e27e29.

14. GD Meckler , C Lowe . To intubate or not to intubate? Transporting infants on prostaglandin E1. Pediatrics 2009; 123: 8.

15. R Punn , NH Silverman . Fetal predictors of urgent balloon atrial septostomy in neonates with complete transposition. J Am Soc Echocardiogr 2011; 24: 425430.

16. AC Martin , ML Rigby , DJ Penny , AN Redington . Bedside balloon atrial septostomy on neonatal units. Arch Dis Child Fetal Neonatal Ed 2003; 88: F339F340.

17. TM Zellers , K Dixon , L Moake , et al. Bedside balloon atrial septostomy is safe, efficacious, and cost-effective compared with septostomy performed in the cardiac catheterization laboratory. Am J Cardiol 2002; 89: 613615.

18. PS McQuillen , SE Hamrick , MJ Perez , et al. Balloon atrial septostomy is associated with preoperative stroke in neonates with transposition of the great arteries. Circulation 2006; 113: 280285.

19. CJ Petit , JJ Rome , G Wernovsky , et al. Preoperative brain injury in transposition of the great arteries is associated with oxygenation and time to surgery, not balloon atrial septostomy. Circulation 2009; 119: 709716.

20. J Beca , J Gunn , L Coleman , et al. Pre-operative brain injury in newborn infants with transposition of the great arteries occurs at rates similar to other complex congenital heart disease and is not related to balloon atrial septostomy. J Am Coll Cardiol 2009; 53: 18071811.

21. SE Applegate , DS Lim . Incidence of stroke in patients with d-transposition of the great arteries that undergo balloon atrial septostomy in the University Healthsystem Consortium Clinical Data Base/Resource Manager. Catheter Cardiovasc Interv 2010; 76: 129131.

22. T Nevvazhay , A Chernogrivov , E Biryukov , et al. Arterial switch in the first hours of life: no need for Rashkind septostomy? Eur J Cardiothorac Surg 2012; 42: 520523.

23. K Chasovskyi , O Fedevych , G Vorobiova , et al. Arterial switch operation in the first hours of life using autologous umbilical cord blood. Ann Thorac Surg 2012; 93: 15711576.

24. EA Newfeld , MM Paul , AJ Muster , FS Idriss . Pulmonary vascular disease in complete transposition of the great arteries: a study of 200 patients. Am J Cardiol 1974; 34: 7582.

25. H Fan , S Hu , Z Zheng , et al. Do patients with complete transposition of the great arteries and severe pulmonary hypertension benefit from an arterial switch operation? Ann Thorac Surg 2011; 91: 181186.

26. MT Roofthooft , KA Bergman , TW Waterbolk , et al. Persistent pulmonary hypertension of the newborn with transposition of the great arteries. Ann Thorac Surg 2007; 83: 14461450.

27. M El-Segaier , L Hellstrom-Westas , G Wettrell . Nitric oxide in neonatal transposition of the great arteries. Acta Paediatr 2005; 94: 912916.

28. C Goissen , L Ghyselen , P Tourneux , et al. Persistent pulmonary hypertension of the newborn with transposition of the great arteries: successful treatment with bosentan. Eur J Pediatr 2008; 167: 437440.

29. S Jaillard , E Belli , T Rakza , et al. Preoperative ECMO in transposition of the great arteries with persistent pulmonary hypertension. Ann Thorac Surg 2005; 79: 21552158.

30. GB Luciani , AC Chang , VA Starnes . Surgical repair of transposition of the great arteries in neonates with persistent pulmonary hypertension. Ann Thorac Surg 1996; 61: 800805.

31. G Wernovsky , D Wypij , RA Jonas , et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation 1995; 92: 22262235.

32. R Heying , E Wehage , K Schumacher , et al. Dexamethasone pretreatment provides antiinflammatory and myocardial protection in neonatal arterial switch operation. Ann Thorac Surg 2012; 93: 869876.

33. VA Schroeder , JM Pearl , SM Schwartz , et al. Combined steroid treatment for congenital heart surgery improves oxygen delivery and reduces postbypass inflammatory mediator expression. Circulation 2003; 107: 28232828.

34. RW Collett , JE Edwards . Persistent truncus arteriosus: a classification according to anatomic types. Surg Clin North Am 1949; 29: 12451270.

35. R Van Praagh , S Van Praagh . Anatomy of common aorticopulmonary trunk (truncus arteriosus communis) and its embryologic implications – a study of 57 necropsy cases. Am J Cardiol 1965; 16: 406407.

36. HM Russell , SK Pasquali , JP Jacobs , et al. Outcomes of repair of common arterial trunk with truncal valve surgery: a review of the society of thoracic surgeons congenital heart surgery database. Ann Thorac Surg 2012; 93: 164169.

37. C Elzein , M Ilbawi , S Kumar , et al. Severe truncal valve stenosis: diagnosis and management. J Card Surg 2005; 20: 589593.

38. T Tlaskal , B Hucin , V Kucera , et al. Repair of persistent truncus arteriosus with interrupted aortic arch. Eur J Cardiothorac Surg 2005; 28: 736741.

39. L Bohuta , A Hussein , TA Fricke , et al. Surgical repair of truncus arteriosus associated with interrupted aortic arch: long-term outcomes. Ann Thorac Surg 2011; 91: 14731477.

40. E Goldmuntz , BS Emanuel . Genetic disorders of cardiac morphogenesis. The DiGeorge and velocardiofacial syndromes. Circ Res 1997; 80: 437443.

41. A Carotti , MC Digilio , G Piacentini , et al. Cardiac defects and results of cardiac surgery in 22q11.2 deletion syndrome. Dev Disabil Res Rev 2008; 14: 3542.

42. AK Ryan , JA Goodship , DI Wilson , et al. Spectrum of clinical features associated with interstitial chromosome 22q11 deletions: a European collaborative study. J Med Genet 1997; 34: 798804.

43. DB McElhinney , HL Hedrick , DM Bush , et al. Necrotizing enterocolitis in neonates with congenital heart disease: risk factors and outcomes. Pediatrics 2000; 106: 10801087.

44. DB McElhinney , D McDonald-McGinn , EH Zackai , et al. Cardiovascular anomalies in patients diagnosed with a chromosome 22q11 deletion beyond 6 months of age. Pediatrics 2001; 108: E104.

46. TH Hoffman , G Wernovsky , AM Atz , et al. Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation 2003; 107: 9961002.

47. L Shen , H Gu , D Wang , et al. Influence of chromosome 22q11.2 microdeletion on postoperative calcium level after cardiac-correction surgery. Pediatr Cardiol 2011; 32: 904909.

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Cardiology in the Young
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