D-Transposition of the Great Arteries, the Rastelli Procedure, and its Complications: Management of a Complex Reoperation

Abstract

DEXTRO-TRANSPOSITION OF the Great Arteries (D-TGA) is the second most common cyanotic heart disease, 1 Cohen MS Eidem BW Cetta F et al. Multimodality imaging guidelines of patients with transposition of the Great Arteries: A report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr. 2016; 29 (-62): 571 Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar with an incidence of 20-to-30 cases per 100,000 live births, amounting to 5%-to-7% of all congenital heart diseases. 2 Haeffele C Lui GK. Dextro-transposition of the Great Arteries: Long-term sequelae of atrial and arterial switch. Cardiol Clin. 2015; 33: 543-558 Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar Advances in surgical techniques now permit these patients to survive into adulthood and live a normal life. 3 Latham GJ Joffe DC Eisses MJ et al. Anesthetic considerations and management of transposition of the Great Arteries. Semin Cardiothorac Vasc Anesth. 2015; 19: 233-242 Crossref PubMed Scopus (7) Google Scholar Before the advent of the modern arterial switch surgery and in some forms of complex D-TGA in the current era, these patients commonly undergo multiple surgeries and subsequent revisions due to anatomic limitations of these complex surgical procedures. Multimodality imaging, including echocardiography, is crucial in understanding the anatomy and pathophysiology of the disease, planning surgically corrective procedures, and assessing associated surgical complications. 1 Cohen MS Eidem BW Cetta F et al. Multimodality imaging guidelines of patients with transposition of the Great Arteries: A report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr. 2016; 29 (-62): 571 Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar , 2 Haeffele C Lui GK. Dextro-transposition of the Great Arteries: Long-term sequelae of atrial and arterial switch. Cardiol Clin. 2015; 33: 543-558 Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar , 3 Latham GJ Joffe DC Eisses MJ et al. Anesthetic considerations and management of transposition of the Great Arteries. Semin Cardiothorac Vasc Anesth. 2015; 19: 233-242 Crossref PubMed Scopus (7) Google Scholar , 4 Kutty S Danford DA Diller GP et al. Contemporary management and outcomes in congenitally corrected transposition of the great arteries. Heart. 2018; 104: 1148-1155 Crossref PubMed Scopus (37) Google Scholar This case illustrates the successful management of a complex reoperation for complications after a Rastelli procedure (RP) in a patient with complex D-TGA.