[Clinical study of a non-conduit repair for complete transposition of the great arteries with ventricular septal defect and pulmonary stenosis].
Between 1991 and 1996, we performed a new technique of non-conduit repair on five consecutive patients with complete transposition of the great arteries associated with ventricular septal defect and pulmonary outflow tract obstruction. There were no late deaths. This technique consisted of constructing an intraventricular tunnel with a patch that connected the left ventricle to the aorta, closing the pulmonary outflow tract, drawing the main pulmonary artery directly to the right ventriculotomy, and reconstructing the new right ventricular outflow tract with a monocusp patch. The main feature of this technique is the long acquisition of the main pulmonary artery by transecting it beneath the pulmonary valve. This technique enables direct anastomosis of the main pulmonary artery to the right ventricle through the natural route without dividing the aorta. In this point, it differs from Lecompte's maneuver which mobilizes the pulmonary arterial bifurcation in front of the ascending aorta. The postoperative clinical results were reviewed on 3 patients who underwent mid-term cardiac catheterization. The age at the operation was 5.8, 3.7, and 2.2 years old and the interval between the operation and the mid-term catheterization was 1.8, 3.0, and 2.1 years, respectively. The postoperative systolic pressure gradient across the right ventricular outflow tract was 4.20 mmHg (mean 10 mmHg) at the early stage and 8-22 mmHg (mean 14 mmHg) at mid-term stage. The right ventriculogram at the mid-term stage showed proportional growth of the right ventricular outflow tract in all patients. We conclude that this technique of non-conduit repair is the most desirable procedure for this type of anomaly.
Nagata
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Department of Thoracic Surgery, Kanagawa Children's Medical Center, Yokohama, Japan.
D006348:Cardiac Surgical Procedures / Q000379:methods; D002675:Child, Preschool; D006345:Heart Septal Defects, Ventricular / Q000150:complications* / Q000601:surgery; D006801:Humans; D011651:Pulmonary Artery / Q000601:surgery; D011666:Pulmonary Valve Stenosis / Q000150:complications* / Q000601:surgery; D014188:Transposition of Great Vessels / Q000150:complications / Q000601:surgery*