Right transatrial approach to relieve pulmonary stenosis in patients with corrected transposition of the great vessels: a new operation without use of an extracardiac conduit.
BACKGROUND
A new operation to relieve pulmonary obstruction is proposed for patients with corrected transposition of the great vessels and pulmonary stenosis (PS). A right transatrial approach involves excising or detaching the right-sided atrioventricular valve (AV). Next, the pulmonary outflow tract is opened wide with an incision extending from the right-sided ventricle upward across the AV valve annulus. This incision extends into the main trunk of the pulmonary artery located behind the right atrium. A patch, with or without implantation of a pulmonary valve prosthesis, widens the outflow tract, thus avoiding use of an extracardiac conduit.


METHODS
We describe this operation performed in a 51-year-old man who had previously undergone correction with an extracardiac conduit that had become obstructed. The patient had severe right-sided AV valve insufficiency and complete heart block with a functioning transvenous pacemaker. We replaced the right-sided AV valve and positioned the permanent pacemaker lead outside of the prosthetic skirt. The PS was corrected as described above and a pulmonary prosthetic valve implanted. Use of an extracardiac conduit was avoided altogether.


CONCLUSIONS
This technique may be applicable even without excising the right-sided AV valve. The clinical result for our patient is still optimal 4 years after surgery.
Molina
J E
JE
Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis, USA.
Wang
Y
Y
Stillman
A E
AE
D006348:Cardiac Surgical Procedures / Q000379:methods; D006325:Heart Atria; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011666:Pulmonary Valve Stenosis / Q000209:etiology* / Q000601:surgery*; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000601:surgery*