Fate of Aorta and Pulmonary Artery in Patients with Dextro-transposition of Great Arteries Undergoing Arterial Switch Operation: A Prospective Study

Dr Rakesh Kumar; Prof Hemant Narayan Roy

Volume : VIII, Issue : III, March - 2019

Fate of Aorta and Pulmonary Artery in Patients with Dextro-transposition of Great Arteries Undergoing Arterial Switch Operation: A Prospective Study

Dr Rakesh Kumar, Prof Hemant Narayan Roy

Abstract :

Background: Following the arterial switch operation, there is a risk of neoaortic root enlargement and aortic regurgitation in follow–up. This study is intended to study whether abnormalities in the histopathological finding of the neo–aorta at the time of the arterial switch operation could lead to these complications. Patients and methods: Between January 2015 to November 2015, 50 consecutive patients undergoing the arterial switch operation were included in this prospective cohort study. A sufficient representative sample of tissue obtained from the native pulmonary artery and the native aortic root, was fixed in 10% neutral buffer formalin and sent to the department of pathology, these tissues were conservatively processed and paraffin blocks were made, sections were cut and stained by H & E, Vanhoeff elastic, Van Giessen, Masson’s trichrome, elastic tissue and smooth muscle was systematically accessed, in the native aorta and native pulmonary artery. Simultaneously a note was made of all the patients pre–operative characteristics, aetiology, associated cardiac anomalies, echocardiogram findings, cardiac catheterization data(if performed), intra operative details, Histo–pathological examination of native aorta and native pulmonary artery, comparison with controls with literature, post operative course, follow up, and follow–up echocardiographic data. Results: Fifty patients had an ASO for TGA between January 2015– November 2015, with We examined elastic lamellar count of native aorta and native pulmonary artery and compared it with the finding described in the literature. It was found that elastic lamellar counts were similar in both the neo–aorta and the neo–pulmonary artery. Hence histo–pathologically they are similar at birth, gradually as the age advances lamellar count decreases in the neo–pulmonary artery. Hence early surgery in patients with d–TGA may prevent against neoaortic root dilatation and aortic regurgitation. Conclusions: There were no gross differences between native pulmonary artery and native aorta histopathology but an inverse relation was found between advancing age and elastic lamellar counts in both structures signifying the need for an early arterial switch to prevent long–term complications.