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Dr. Andrew Rynne
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Dr. Andrew Rynne

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What causes late left pulmonary artery stenosis after d-TGA surgery?

Answered by
Dr.
Dr. Priyank Mody

Cardiologist

Practicing since :2009

Answered : 910 Questions

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Posted on Wed, 31 Aug 2016 in Valvular Heart Disease
Question: My child had a DTGA surgery around 2 month back. During our routine check up we found stenosis LPA is less than RPA. I want to know how serious it is??
doctor
Answered by Dr. Priyank Mody 49 minutes later
Brief Answer:
Do upload the echocardiography reports and the operative details

Detailed Answer:
Hello ,
I am Dr. Mode and I would be addressing your concern .

For an comprehensive opinion I would like to know details about 3 things.
Pre operative echocardiography.
Operative notes ( surgical details) and the post operative echo study.
Do upload the same if possible. Lastly is your son symptomatic.
Would be waiting for reports from your side.

Regards Dr. Priyank Mody
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Priyank Mody 29 minutes later
Please find the eco done before surgery. Operation notes. And eco post surgery.
Image 13,14= present eco after surgery.
Image 15,16= Eco before surgery.
Image 17,18= surgery notes.
doctor
Answered by Dr. Priyank Mody 20 hours later
Brief Answer:
A close follow up n in future, non invasive intervention is a possibility

Detailed Answer:
Hello ,
I went through the reports , I would enlist my observations .
1) It was ideal decision to perform the ASO surgery for DTGA at 1 month as that would give him best chances of survival and a good quality of life in future .
As the best decision was taken by the doctors than .
2) Now pre operative echo didn't have branch pulmonary artery stenosis.
Now during the surgery as you understand a 1 month baby shower heart is too small and it's a very fine procedure . So during the Le compte , the pulmonary artery are Brough anteriorly to aorta and is and important part of the procedure , however during this the anterior tried may kink or get stretched ,which is inherent part of the procedure because of smaller size of the pulmonary arteries.

So now how do we follow up .
There is for sure a component of branch pulmonary artery stenosis and will require close follow up .
At present the Rv pressure are still sub systemic and hence a close echo follow up say every 3 months or as told by your doctor is suggested so that baby can grow as much as possible before any intervention is needed .
In future something may be needed for this , which particularly depends on how the Right ventricle holds up .
However when needed cardiac catheterisation to know the exact pressure and than now non invasive intervention by putting an expandable short formula stent is is a good option in an experienced hands . An option you may discuss with your doctor . This would save us another surgery .

Now I would like you to understand that pediatric cardiology is an highly subjective field and your doctor who has examined your baby is the best person to take a call on what's best for the baby .
I would reassure you that ASO surgery are the few surgeries in cardiology which gives excellent long term results .
So trust your doctor and maintain a close follow up .
Let me know if any clarification is needed
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Priyank Mody 21 minutes later
Does he need the balloon surgery at this point? And if it's done now, will there be any complications?? And is it safe for long term?
Dr told us to visit after 6 months.
Do stenosis gets cured with age? Or surgery is eminent?
doctor
Answered by Dr. Priyank Mody 20 hours later
Brief Answer:
Follow up with close monitoring of Rv function is best

Detailed Answer:
Hello ,
Balloon surgery is not needed at this point and a close follow up is better .
Balloon surgery is dilatation of the stenosis with balloon . However as you know that arteries are elastic and hence there is good amount of recoil , so it's not the best be a sure now or in future .
Presently we should allow the baby to grow as much as possible with close monitoring to make sure that the right heart is adopting well .
With age the arteries grow and good blood flow may decrease the stenosis , however the chances for the same it less .
The best procedure changes with baby age and the hemodynamics during that stage . However as I said there are alternatives to surgery in future which has equivalent results .
Lastly I would like to reassure you that the most risky and difficult surgery has already been done at right time , and considering God has been kind then , he will surely be helpful later .
Keep a trust in your doctor and follow his advise as timing is most crucial in pediatric surgery .
Adding unnecessary stress would not be of much value . XXXXXXX Is one of the best hospitals in pediatric surgery in XXXXXXX .

Hopefully I could answer you . There are no absolute answers about future as human body and medicine itself changes with time .
Regards Dr. Priyank Mody
Above answer was peer-reviewed by : Dr. Priyanka G Raj
doctor
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Follow up: Dr. Priyank Mody 7 minutes later
Thanks Dr..
doctor
Answered by Dr. Priyank Mody 32 hours later
Brief Answer:
Thanks

Detailed Answer:
Thanks for consulting me
Take care
Dr Mody

Above answer was peer-reviewed by : Dr. Vaishalee Punj
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