[New technique of non-conduit repair for type III transposition of the great arteries: differences from Lecompte procedure and how to do it].
Lecompte reported in 1982 an innovative technique to reconstruct the pulmonary outflow tract without using prosthetic conduit in the transposition of the great arteries (TGA) with ventricular septal defect (VSD) and pulmonary stenosis (PS). In this group, however, the Lecompte procedure appears to have some difficulties translocating the pulmonary bifurcation anterior to the ascending aorta and unable to make a physiological right ventricular outflow tract preventing pulmonary valve regurgitation. A new technique now we present consists of following:(1) The main pulmonary trunk is transected subvalvularly and connected directly to the right ventriculotomy via the left side of the ascending aorta from behind and (2) intraventricular tunnel is made with prosthetic patch directing the left ventricular blood to the aorta via VSD and (3) right ventricular outflow tract is reconstructed with PTFE patch which bears a sinus-formed monocusp possessing corpora Arantii. Three consecutive patients, aged 5.8, 3.7 and 2.2 years, were treated by this technique, with excellent result. Transannular systolic pressure gradients ranged 4 to 20 mmHg (mean 10 mmHg) and each monocusp was highly competent preventing pulmonary regurgitation. All the patients were able to return home within a month after the operation. We conclude that the main pulmonary trunk can be directly connected to the right ventricle by the natural route if its full extent is efficiently utilized. This technique also facilitates the insertion of competent pulmonary valve which brings good result in the postoperative cardiac performance.
Nagata
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Department of Thoracic Surgery, Kanagawa Prefectural Children's Medical Center, Japan.
D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D011651:Pulmonary Artery / Q000601:surgery; D014188:Transposition of Great Vessels / Q000601:surgery*