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Adult Congenital Heart Disease - Part 5

Sau khi chuyển đổi tâm nhĩ thủ tục, một trong những biến chứng sau đây có thể xảy ra: - đáng kể hệ thống (ba lá) truyền nhĩ thất (AV) van nôn (40%); - hệ thống rối loạn chức năng tâm thất phải (40%); - triệu chứng nhịp tim chậm (xoang nút rối loạn chức năng, AV nút chặn) (50%) - rung động và rung tâm nhĩ (20% theo độ tuổi 20) | 106 Chapter 13 tricle to the pulmonary artery. By virtue of this procedure the left ventricle supports the systemic circulation. Late complications Following atrial switch procedure one of the following complications may occur - significant systemic tricuspid atrioventricular AV valve regurgitation 40 - systemic right ventricular dysfunction 40 - symptomatic bradycardia sinus node dysfunction AV node block 50 - atrial flutter and fibrillation 20 by age 20 - superior or inferior vena cava pathway obstruction - pulmonary venous obstruction rare - atrial baffle leak. Following arterial switch procedure the following complications may occur - right ventricular outflow tract obstruction - neo-aortic valve regurgitation - myocardial ischemia from coronary artery obstruction. Following the Rastelli procedure the following complications may occur - right ventricle-to-pulmonary artery conduit stenosis - significant subaortic obstruction across LV-aorta tunnel - residual VSD. Recommended follow-up Regular follow-up by physicians with special expertise in adult congenital heart disease is recommended. Atrial switch serial follow-up of systemic right ventricular function is warranted. Echocardiography and RNA can be used although MRI is especially useful. Arterial switch regular follow-up with echocardiography is recommended. Rastelli regular follow-up with echocardiography is warranted given the inevitability of conduit degeneration over time. Holter monitoring is recommended to diagnose unacceptable brady- or tachyarrhythmias. Endocarditis recommendations All patients with DTGA status after atrial switch or Rastelli procedure should take SBE prophylaxis for life. Patients with DTGA status after arterial switch should take SBE prophylaxis if any residual hemodynamic disturbances are present mild pulmonary stenosis aortic regurgitation etc. . Exercise In the absence of severe cardiomegaly or severe pulmonary hypertension patients should be restricted to class 1A type .