CARDIOLOGICAL AND GENERAL HEALTH-STATUS IN PRESCHOOL-CHILDREN AND SCHOOL-AGE-CHILDREN AFTER NEONATAL ARTERIAL SWITCH OPERATION

Objective: Cardiological and general health status 3-9 years after neo natal arterial switch operation for transposition of the great arterie s should be evaluated by non-invasive methods. Methods: A total of 77 unselected children with intact ventricular septum (75.3%) or ventricu lar septal defect (24.7%) without or with aortic isthmic stenosis (5.2 %) were prospectively examined 3.2-9.4 years (5.4 +/- 1.6) after neona tal switch. Clinical pediatric and cardiological examination, standard and 24 h Holter electrocardiogram, M-mode, 2D-, Doppler and colour Do ppler echocardiography were performed. Outcome data were compared to p ublished normals. Results: Reoperation rate was 2.6%, 96.1% were witho ut limitation of physical activity and 98.7% without medication. Compa red to normals, growth was adequate, weight and head circumference wer e slightly reduced. After median sternotomy, 23.4% had abnormal thorac ic configuration (16.9% asymmetry, 6.5% funnel chest). ECG and Holter: 93.5% were in sinus, 6.5% in ectopic atrial or junctional rhythm. Inc idence of complete right bundle branch block was 15.8% in patients wit h ventricular septal defect and 5.2% in those without. Ischemic ST-T c hanges during exercise due to coronary artery occlusion and evidence o f old myocardial infarction were found in 1 patient (1.3%) each. Occas ional atrial ectopy was found in 27.4%, ventricular ectopy in 15.3%: o ccasional in 12.5% and frequent (> 30/h) in 2.8% presenting bigemini, couplets and short runs of ventricular tachycardia at rest and during exercise. Echocardiography: Left ventricular function was normal in al l. Endsystolic diameter of neoaortic valve annulus was beyond 90% conf idence interval for controls in 79.2%, neoaortic root diameter in 100% . Mild aortic insufficiency was seen in 10.4%. No correlation was foun d between aortic insufficiency and aortic dilatation. Neoaortic stenos is was not seen, mild residual coarctation after end-to-end-anastomosi s was found in 2.6% native coarctation corrected later on in 1.3%. Sup ravalvular pulmonary stenosis was seen in 29.9% (19.5% trivial, 7.8% m ild, 2.6% moderate), mild subvalvular pulmonary stenosis in 1.3%, pulm onary insufficiency in 2.6%. Conclusion: The study confirms good midte rm results after neonatal arterial switch operation for transposition with or without ventricular septal defect. Long-term observation is ne cessary to assess rhythm, coronary artery and myocardial function as w ell as development of neo-aorta and pulmonary artery system. (C) 1997 Elsevier Science B.V.