Prevalence and surgical approach of supravalvular pulmonary stenosis after Jatene operation for transposition of great arteries.
BACKGROUND
The Transposition of the Great Arteries is the most frequent congenital cyanogenic cardiopathy in the neonatal period, corresponding to 7% of all congenital cardiopathies. Among the operations for surgical treatment, the Jatene operation, with arterial correction, is the treatment of choice. During the late postoperative evolution, some problems were observed, with the most common being the occurrence of supravalvular stenosis at the neopulmonary, regardless of the type of surgical technique used.


OBJECTIVE
To study and analyze the prevalence of stenosis, as well as describe the surgical treatment and propose technical maneuvers to prevent its onset.


METHODS
Of the 553 patients that underwent surgery, 409 were discharged from the hospital and 281 had late follow-up; 59 (20.9%) presented different degrees of supravalvular pulmonary stenosis and 21 had a mean gradient > 60 mmHg, needing surgical treatment. Depending on the location and anatomy of the stenosis, the surgical treatment consisted of the use of different techniques, such as the enlargement of stenosis areas with bovine pericardium patches, resection of stenotic areas and termino-terminal anastomosis, replacement of retracted patches and synthetic tubes.


RESULTS
Twenty patients presented good evolution and only one patient died.


CONCLUSIONS
It can be concluded that the supravalvular pulmonary stenosis, post-Jatene operation for Transposition of Great Arteries, had a prevalence of 20.9%; once identified and with indication for treatment, it can be treated surgically with low mortality levels, through different surgical techniques; to prevent the occurrence of stenosis, ample dissection and release of the pulmonary branches, double anastomoses, large patches of autologous pericardium and careful reconstruction of the aorta are proposed, which prevents the compression of the neopulmonary.
Jatene
Marcelo Biscegli
MB
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. mbjatene@cardiol.br
Jatene
Ieda Biscegli
IB
Oliveira
Patrícia Marques de
PM
Moysés
Rafael Aon
RA
Souza
Luis Carlos Bento de
LC
Fontes
Valmir
V
Miura
Nana
N
Lopes
Antonio Augusto
AA
Marcial
Miguel Barbero
MB
Jatene
Adib Domingos
AD
D000818:Animals; D001938:Brazil / Q000453:epidemiology; D002417:Cattle; D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D010496:Pericardium; D011183:Postoperative Complications; D011184:Postoperative Period; D015995:Prevalence; D011651:Pulmonary Artery / Q000473:pathology / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D014188:Transposition of Great Vessels / Q000150:complications / Q000601:surgery*