ABSTRACT
Objective: The arterial switch operation is the standard
treatment for the transposition of the great arteries. The timely
variation in the residual pressure gradient across the pulmonary
arteries is ill-defined. This work is aimed to study the progressive
changes in the pressure gradient across the pulmonary valve and
pulmonary arteries after arterial switch operation (ASO).
Methods: All eligible patients for this study who underwent
arterial switch operation between 2000 and 2019 were reviewed.
Transthoracic echocardiography (TTE), was used to estimate the peak
pressure gradient across the pulmonary artery and its branches. The
primary outcome was the total peak pressure gradient (TPG) which is the
sum of peak pressure gradients across the main pulmonary artery and
pulmonary artery branches. Furthermore, a longitudinal data analyses
with mixed effect modeling were used to determine the independent
predictors for the changes in pressure gradient.
Results: 309 patients were included in the study. Over 17-year
follow up, the freedom from pulmonary stenosis reintervention was 95%
(16 out of the 309 patients underwent reintervention = 5%). the
Longitudinal data analyses of serial 1844 echocardiographic studies for
the included patients revealed that the TPG recorded in the first
postoperative echocardiogram across pulmonary valve, right and left
pulmonary artery branches was the most significant predictor for
reintervention.
Conclusion: The total peak gradient measured in the first
postoperative echocardiogram is the most important predictor for
reintervention. We propose that a total peak gradient in the first
postoperative echocardiography of 55 mmHg or more is a predictor for
reintervention.