Intraventricular rerouting for transposition of the great arteries with posterior aorta: Ventricular septal defect creation and total resection of the infundibular septum

Abstract

Atypical transposition of the great arteries (TGA), in which the aorta was situated posteriorly and the pulmonary artery (PA) was situated anteriorly, was reported in 1971. In this TGA with a posterior aorta, the aorta rises from the right ventricle (RV) but retains fibrous aortic-mitral continuity, and the PA arises from a muscular conus above the left ventricle (LV). The principal surgical options are arterial or atrial switch combined with the ventricular septal defect (VSD) closure. In this anomaly, the VSD assumes a slit form, and the infundibular septum (IS) interferes with the LV-aorta route by the good alignment of the IS and the intraventricular septum (Figure 1, A), which makes the biventricular repair with intraventricular rerouting difficult in cases with pulmonary stenosis (PS). We performed intraventricular rerouting by subpulmonary VSD creation and total resection of the IS for this disease complicated by PS (Figure 1, B). In this report, our procedure is described and discussed.