EXPERIENCE OF SURGICAL TREATMENT OF MAJOR VESSEL TRANSPOSITION

Imanov E., Plyska O. I., Dzyurii I. V., Sloboda A. O., Truba Y. P., Lazoryshynets V. V.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Abstract. Purpose of work: analysis of immediate and long-term results of surgical treatment with transposition of great vessels. Object and research methods. Surgical treatment of transposition of great vessels was performed in 54 patients. Of these, 15 are female (28%) and 39 (72%) are male. At the same time, in 42 patients the interventricular septum was intact, in 12 it had a defect. All patients underwent Arterial switch operation. In 85% of patients, the defect was diagnosed prenatally and confirmed by Echo-KG immediately after birth, in 15% of cases – after birth. Nine (1.6%) patients had abnormal anatomy of the branching and branching of the coronary vessels. Results. Surgical treatment of magistral vessel transposition of patients was carried out in two stages. At the first stage, the Rashkind procedure was performed for urgent indications using balloon atrioseptostomy: in 36% – in the first hours after hospitalization, in 64% – the next day. After the Rashkind procedure, the condition of all patients improved, blood oxygen saturation increased by 25-50%. Subsequently, the patients underwent an Arterial switch operation. Hospital mortality after arterial switch operation was 3.7% (n=3). Its causes were: a) severe myocardial insufficiency (n=1), which was caused by left ventricular myocardial infarction associated with technical difficulties of coronary artery reimplantation; b) bilateral polysegmental pneumonia (n=2). In the postoperative period of patients, various complications were identified that worsened the patient’s condition. This is acute respiratory failure – 7 cases; acute renal failure – 4 cases; purulent-septic complications – 3 cases; paresis of the diaphragm – 1 case; resternotomy for bleeding – 1 case; dilated chest due to severe heart failure – 4 cases. There were no fatal cases in the long-term period. There were complications in the long-term period of the arterial switch operation, which were subsequently resolved surgically and endovascularly. This is neoaortic valve insufficiency – 7 cases; pulmonary valve stenosis – 5 cases. After 3-5 years, all patients underwent planned coronary angiography. Revealing neoaortic valve insufficiency (grade I-II) in 7 patients did not require surgical intervention. He undergoes further routine observation annually. In the presence of stenosis of the pulmonary artery, balloon dilatation was performed (n=3), and two patients underwent pulmonary artery stenting. The reasons for these consequences were both iatrogenic and physiological features of the structures. The majority of patients were without significant long-term consequences. Conclusions: Surgical treatment of transposition of great vessels by arterial switch operation has good immediate and long-term results. Balloon atrioseptostomy is a procedure that stabilizes the child’s condition and improves treatment outcomes. Prenatal diagnosis of transposition of great vessels makes it possible to provide timely care to newborns with this critical heart defect in specialized cardiac surgery facilities.

congenital heart disease, transposition of great vessels, open heart surgery, Rashkind’s procedure.

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«Bulletin of problems biology and medicine» Issue 3 (161), 2021 year, 117-121 pages, index UDK 616.12-007.2-053.2-089

10.29254/2077-4214-2021-3-161-117-121