Author + information
- Received February 26, 1992
- Revision received June 25, 1992
- Accepted July 23, 1992
- Published online February 1, 1993.
- Gil Wernovsky, MD, FACC∗,
- Nancy D. Bridges, MD,
- Valerie S. Mandell, MD,
- Aldo R. Castaneda, MD, FACC and
- Stanton B. Perry, MD
- ↵∗Address for correspondence: Gil Wernovsky. MD, Cardiac Intensive Care Unit, Parley 653, Children's Hospital. 300 Longwood Avenue, Boston, Massachusetts 02115.
Objectives. This study was undertaken to define the incidence of enlarged bronchial arteries after early surgical repair of transposition of the great arteries by the arterial switch operation, and to report the results of catheter-directed therapy in five patients.
Background. Pathologic and angiographic studies have demonstrated enlarged bronchial arteries in patients with transposition of the great arteries.
Methods. A subjective 4-point scale was used to grade postoperative angiograms performed in 119 patients at our institution between January 1983 and December 1991. Grades 0 and 1 were designated if there was no opacification of the pulmonary arteries or veins, whereas grades 2 and 3 were assigned if there was such opacification. The median age at repair was 8 days (range 1 day to 13 months) and the median age at catheterizatian was 11.2 months (range 3.6 to 58.5). An intact vernicular septum was present in 84 (71%) of 119 patients.
Resalts. Significantly increased broachial flow (grade 2 or 3) was present in 55 (46%) of 119 patients. Age at repair, age at catheterization and interval between repair and catheterization were not associated with significantly increased bronchial flow; however, an intact ventricular septum was weakly associated with increased flow (p = 0.04). Coil emholization was performed in live patients with complete occlusion of the vessels and no significant complications.
Conclusions. Abnormally enlarged bronchial arteries are frequently identified at postoperative catheterization despite early repair and may explain continuous murmurs or persistent cardiomegaly in patients with otherwise normal noninvasive findings. When clinically indicated, catheter-directed therapy can be performed with good results.
☆ This study was supported in part by Grant HL41786 from the National Heart, Lung, and Blood Institute. National Institutes of Health, Bethesda, Maryland.
- Received February 26, 1992.
- Revision received June 25, 1992.
- Accepted July 23, 1992.