title: Prevalence and surgical approach of supravalvular pulmonary stenosis after Jatene operation for transposition of great arteries.
abstract: 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.
authors.affiliation: Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. mbjatene@cardiol.br
authors.forename: Marcelo Biscegli
authors.initials: MB
authors.lastname: Jatene
authors.forename: Ieda Biscegli
authors.initials: IB
authors.lastname: Jatene
authors.forename: Patrícia Marques de
authors.initials: PM
authors.lastname: Oliveira
authors.forename: Rafael Aon
authors.initials: RA
authors.lastname: Moysés
authors.forename: Luis Carlos Bento de
authors.initials: LC
authors.lastname: Souza
authors.forename: Valmir
authors.initials: V
authors.lastname: Fontes
authors.forename: Nana
authors.initials: N
authors.lastname: Miura
authors.forename: Antonio Augusto
authors.initials: AA
authors.lastname: Lopes
authors.forename: Miguel Barbero
authors.initials: MB
authors.lastname: Marcial
authors.forename: Adib Domingos
authors.initials: AD
authors.lastname: Jatene
mesh_terms: 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*