Abstract
The purpose of the study is to identify the most significant causes of the development of rhythm and conduction disturbances
in the long-term period after the arterial switch operation (arterial switch – AS).
Materials and methods. A single-center retrospective cohort study of the outcomes of treating 248 patients with transposition
of great arteries (TGA) has been conducted. All the patients underwent an arterial switch operation at the
clinic. The study covered patients who had had TGA with intact ventricular septum, TGA with ventricular septal
defect (TGA-VSD), obstruction of the right or left ventricle outflow tract (RVOT, LVOT), aortic arch hypoplasia and
aorta coarctation. The mean age at the moment of the AS operation was 29.9±3.5 days. The patients with TGA and
intact VS who had been admitted at an age of more than 14 days underwent the pulmonary artery narrowing operation
at the 1st stage and the AS operation at the 2nd stage. Among the patients who underwent the operation in
1 stage, the mean age was 13.4±2.4 days. The mean age was 6.9±1.5 months at the moment of the radical correction
in the group of the children who underwent the 2-staged correction (with narrowing the pulmonary artery).
Results. In the long-term period after the arterial switch operation, according to the results of the study, the incidence
of arrhythmias was 29.8% (74 patients). Most often, patients complained of heart failure, headache, weakness, and
dizziness. All patients with suspected rhythm and conduction disturbances were monitored daily for ECG monitoring
and revealed that supraventricular tachycardia in the form of paroxysmal atrial flutter and atrial fibrillation
occurred in 61 (24.6%) patients, nodal tachycardia in 7 (2.8%) patients, 5 (2%) patients had hemodynamically significant
ventricular extrasystoles and 1 (0.4%) patient had ventricular tachycardia.
Conclusion. The maximum possible reduction in the duration of the clamping of the aorta; elimination of hypoxia in
the preoperative period by ensuring normal mixing of blood at all anatomical levels (atrial septal defect, ventricular
septal defect, patent ductus arteriosus); prevention of severe anemia in the preoperative period, since the severity of
hypoxia depends significantly on the concentration of hemoglobin in the blood; minimize the frequency of palliative
surgery (banding – PAB).
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About the authors
- Leo A. Bockeria, Academician of RAN and RAMS, Director; orcid.org/0000-0002-6180-2619
-
Inessa E. Nefedova, Cand. Med. Sc., Head of Department; orcid.org/0000-0002-9221-051X
-
David O. Berishvili, Dr. Med. Sc., Head of Department; orcid.org/0000-0001-7379-345X
-
Dmitry V. Adkin, Cand. Med. Sc., Pediatric Cardiologist; orcid.org/0000-0002-2184-8225
-
Alina S. Sarkisyan, Cardiologist; orcid.org/0000-0001-6273-0808
-
Vera V. Astakhova, Junior Researcher; orcid.org/0000-0001-9940-4440
