Late complication of the atrial switch operation for d-transposition of the great arteries in early childhood

Background and objective: The atrial switch operation in patients with tran sposition of the great arteries have been replaced by the arterial switch o peration in the neonatal period. However, an increasing number of atrial sw itch survivors has now reached adulthood. This study was aimed at evaluatin g the incidence and patterns of typical late complications in order to desc ribe diagnostic and therapeutic options. Patients and Methods: We retrospectively analysed the data of 40 adolescent and adult patients, who had an atrial switch operation a mean of 17,9 year s ago (23 Senning, 17 Mustard operations). The mean age of the patients is 19,3 years with 40% females. The follow up time in our institution was 4,7 years. Results: The most frequent complications were cardiac rhythm disturbances ( 47,5% loss of sinus rhythm, 22,5% intermittent atrial flutter, 22,5% juncti onal rhythm, 7,5% paroxysmal supraventricular tachycardia, 17,5% sick sinus syndrome, 5% premature ventricular contractions), severe tricuspid regurgi tation (15%), severe right ventricular failure (5%), baffle leaks (27,5%), baffle obstructions (17,5%), and pulmonary artery hypertension (27,5%). Conclusion: The data demonstrate that adult patients who underwent atrial s witch operation in early childhood need long term follow-up to allow early recognition and treatment of late complications, even in asymptomatic patie nts.