title: Effects of surgical en bloc rotation of the arterial trunk on the conduction system in children with transposition of the great arteries, ventricular septal defect and pulmonary stenosis.
abstract: OBJECTIVE
  The standard surgical management of patients with transposition of the great arteries, ventricular septal defect, and pulmonary stenosis is the Rastelli operation. Recently, en bloc rotation of the arterial trunk, by cutting out the aortic and the pulmonary root in one block and by rotating it 180°, has been introduced as a new option for anatomical repair.
  
  
  METHODS
  To evaluate the effects of this surgical method on the conduction system, pre-operative, post-operative, and follow-up electrocardiograms as well as patient charts were reviewed retrospectively. A total of 16 consecutive patients with transposition of the great arteries and left outflow tract obstruction were treated with en bloc rotation.
  
  
  RESULTS
  During the post-operative period, there were two patients with complete atrio-ventricular block, one with junctional ectopic tachycardia, one with ventricular tachycardia, and one with supraventricular tachycardia. None of the patients had a typical right bundle branch block pattern before surgery; however, this pattern was detectable after surgery in eight out of 16 patients (50%), which persisted during the follow-up. All patients without typical right bundle branch block pattern showed a median QRS duration of 65 ms (54-112 ms) before surgery, 62 ms (54-122 ms) after surgery, and 84 ms (66-128 ms) at the last follow-up visit. This compares well with a similar Rastelli cohort, where a right bundle branch block prevalence of 77% was reported. Out of 16 patients, 12 showed non-specific ST changes and negative T-waves, which persisted during follow-up with an unknown significance for the future.
  
  
  CONCLUSIONS
  Our data suggest that en bloc rotation of the arterial trunk seems not to have more negative effects on the conduction system than the Rastelli operation.
authors.affiliation: 1Department of Pediatric Cardiology,Children's Heart Center Linz,Linz,Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Prandstetter
authors.affiliation: 1Department of Pediatric Cardiology,Children's Heart Center Linz,Linz,Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Tulzer
authors.affiliation: 2Department of Pediatric Cardiac Surgery,Children's Heart Center Linz,Linz,Austria.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Mair
authors.affiliation: 2Department of Pediatric Cardiac Surgery,Children's Heart Center Linz,Linz,Austria.
authors.forename: Eva
authors.initials: E
authors.lastname: Sames-Dolzer
authors.affiliation: 1Department of Pediatric Cardiology,Children's Heart Center Linz,Linz,Austria.
authors.forename: Gerald
authors.initials: G
authors.lastname: Tulzer
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery; D001011:Aorta / Q000601:surgery; D000069278:Arterial Switch Operation; D001317:Austria; D053840:Brugada Syndrome / Q000503:physiopathology*; D000075224:Cardiac Conduction System Disease; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D007223:Infant; D011183:Postoperative Complications; D011666:Pulmonary Valve Stenosis / Q000601:surgery*; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000601:surgery*; D016896:Treatment Outcome; D014338:Truncus Arteriosus / Q000601:surgery; D014694:Ventricular Outflow Obstruction / Q000601:surgery*
keywords: En bloc rotation of the truncus arteriosus; Rastelli procedure; aortic root translocation; left ventricular outflow tract obstruction; pulmonary stenosis; transposition of the great arteries