title: Pulmonary root translocation in malposition of great arteries repair allows right ventricular outflow tract growth.
abstract: OBJECTIVE
  Optimal surgical treatment of patients with transposition of the great arteries (TGA), ventricular septal defect (VSD), and pulmonary stenosis (PS) remains a matter of debate. This study evaluated the clinical outcome and right ventricle outflow tract performance in the long-term follow-up of patients subjected to pulmonary root translocation (PRT) as part of their surgical repair.
  
  
  METHODS
  From April 1994 to December 2010, we operated on 44 consecutive patients (median age, 11 months). All had malposition of the great arteries as follows: TGA with VSD and PS (n = 33); double-outlet right ventricle with subpulmonary VSD (n = 7); double-outlet right ventricle with atrioventricular septal defect (n = 1); and congenitally corrected TGA with VSD and PS (n = 3). The surgical technique consisted of PRT from the left ventricle to the right ventricle after construction of an intraventricular tunnel that diverted blood flow from the left ventricle to the aorta.
  
  
  RESULTS
  The mean follow-up time was 72 ± 52.1 months. There were 3 (6.8%) early deaths and 1 (2.3%) late death. Kaplan-Meier survival was 92.8% and reintervention-free survival was 82.9% at 12 years. Repeat echocardiographic data showed nonlinear growth of the pulmonary root and good performance of the valve at 10 years. Only 4 patients required reinterventions owing to right ventricular outflow tract problems.
  
  
  CONCLUSIONS
  PRT is a good surgical alternative for treatment of patients with TGA complexes, VSD, and PS, with acceptable operative risk, high long-term survivals, and few reinterventions. Most patients had adequate pulmonary root growth and performance.
authors.affiliation: Cardiovascular Surgery Division, Beneficencia Portuguesa Hospital, São Paulo, Brazil. dasilvajp@uol.com.br
authors.forename: José Pedro
authors.initials: JP
authors.lastname: da Silva
authors.forename: Luciana da Fonseca
authors.initials: Lda F
authors.lastname: da Silva
authors.forename: Lilian Maria
authors.initials: LM
authors.lastname: Lopes
authors.forename: Luiz Felipe
authors.initials: LF
authors.lastname: Moreira
authors.forename: Luiz Fernando
authors.initials: LF
authors.lastname: Caneo
authors.forename: Sonia Meiken
authors.initials: SM
authors.lastname: Franchi
authors.forename: Alessandro Cavalcanti
authors.initials: AC
authors.lastname: Lianza
authors.forename: José Francisco
authors.initials: JF
authors.lastname: Baumgratz
authors.forename: Jefferson
authors.initials: J
authors.lastname: Duarte Flavio Magalhaes
mesh_terms: D000015:Abnormalities, Multiple; D001938:Brazil; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D004310:Double Outlet Right Ventricle / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D011664:Pulmonary Valve / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000254:growth & development / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography; D016278:Ventricular Function, Right