Half rotation of the truncus arteriosus plus arterial switch for transposition of the great arteries with ventricular septal defect and pulmonary outflow tract obstruction

Abstract

The goal of our study was to report our experience of using half rotation of the truncus arteriosus plus arterial switch, as a modification of the Nikaidoh procedure, for anatomic repair of transposition of the great arteries (TGA) with ventricular septal defect (VSD) and pulmonary outflow tract obstruction (pulmonary stenosis (PS)). From December 2006 to December 2009, 11 patients (six male, five female) underwent half rotation of the truncus arteriosus plus arterial switch for repair of TGA, VSD, and PS or double-outlet right ventricle (DORV) at our heart center. There was no operative death. All patients had relief of left ventricular outflow tract obstruction (LVOTO) as determined by direct pressure measurements intraoperatively. Echocardiography was performed for all patients intraoperatively and before discharge. Two patients had mild aortic regurgitation and two patients had mild pulmonary regurgitation. For a median follow-up of 15 months (range 6-42 months), all patients were alive. Echocardiography was performed at 3, 6, 12, 24 and 36 postoperative months. All patients have normal ventricular function. No evidence of LVOTO was founded in all patients. Two patients had mild aortic regurgitation and three patients had mild to medium pulmonary regurgitation. Half rotation of the truncus arteriosus plus arterial switch, as a modification of the Nikaidoh procedure, is a good alternative treatment for complete anatomic repair for TGA, VSD, and PS or DORV with malposition of great arteries and PS. The technique might allow to reconstruct biventricular outflow tract, preserve competence and growth potential of the pulmonary root with valves and decrease the probability of reoperation. Its long-term benefits need to be evaluated with a large number of patients and longer follow-up.