Anatomic Correction Of Transposition Research Articles

Techniques and pitfalls of coronary arterial reimplantation in anatomical correction of transposition.

We assessed the anatomical variations in coronary arterial patterns relative to the techniques of reimplantation in the setting of the arterial switch operation, relating the variations to influences on outcomes. We reviewed pertinent published investigations, assessing events reported following varied surgical techniques for reimplantation of the coronary arteries in the setting of the arterial switch procedure. The prevalence of reported adverse events, subsequent to reimplantation, varied from 2% to 11%, with a bimodal presentation of high early and low late incidence. The intramural pattern continues to contribute to mortality, with some reports of 28% fatality. The presence of abnormal course relative to the arterial pedicles in the setting of single sinus origin was associated with a three-fold increase in mortality. Abnormal looping with bisinusal origin of arteries was not associated with increased risk. The techniques of transfer of the coronary arteries can be individually adapted to cater for the anatomical variations. Cardiac surgeons, therefore, need to be familiar with the myriad creative options available to achieve successful repair when there is challenging anatomy. Long-term follow-up will be required to affirm the superiority of any specific individual technique. Detailed multiplanar computed-tomographic scanning can now reveal all the variants, and elucidate the mechanisms of late complications. Coronary angioplasty or surgical revascularization may be considered in selected cases subsequent to the switch procedure.

Left Main Coronary Artery Stenting in a Neonate After Arterial Switch Operation for Transposition of the Great Arteries

Anatomical correction of transposition of the great arteries (TGA) with an intramural coronary artery is associated with high risk of coronary complications such as vessel injury and stenosis. Here, we report on a case of left main coronary artery stenting in a neonate with single coronary artery after repair for TGA.

Two Challenging Translocation Procedures for Intramural Coronary Arteries in the Setting of Transposition of Great Arteries

Translocation of the coronary arteries remains a technical challenge in anatomic correction of transposition of great arteries. Myocardial ischemia related to the difficulties with coronary relocation is an important factor in perioperative and postoperative morbidity and mortality, particularly in the patients with complex coronary artery anatomy. Intramural coronary artery is a rare anatomic variety which may complicate the arterial switch operation in 2% to 4.6% of the reported cases. Even in the hands of experts, the mortality rate may be in twofold in this subset of patients compared with simple transposition of great artery procedures. In this report, 2 successful translocation techniques for intramural coronary arteries in the setting of arterial switch operation are described.

Anatomical correction of transposition of the great vessels, atrioventricular septal defect and subpulmonary obstruction in an adult

An 18 year old female patient was admitted with cyanosis from birth and easy fatigability since 5 years of age. She had been having palpitations for the past 2 years but no medical opinion was sought. An episode of haemoptysis prompted her to seek medical advice. There was no other positive medical or surgical history and the family history was non-contributory. On examination, the patient appeared well nourished and had cyanosis and Grade III clubbing of the finger and toe nails. Blood pressure was 110/80 mm Hg and all peripheral pulses were well palpable. Jugular venous pressure was not raised. Auscultation of the chest revealed a loud second heart sound with a soft and delayed pulmonary component. There was a grade 3 /6 ejection systolic m u r m u r in the third and four th intercostal space in the left parasternal region and a separate grade 3/6 holosystolic murmur at the cardiac apex. Plain radiograph of the chest revealed prominent bronchovascular markings and a narrow pedicled heart wi th egg-on-s ide appearance . There was mi ld cardiomegaly. Electrocardiogram revealed right axis

Experience with Anatomical Correction of Transposition of the Great Arteries (TGA)

During the past seven years, 102 patients with TGA have been operated on using the switch operation. Overall early mortality was 5.9%, late mortality 2.%. Sixty-three newborns had an intact septum and were corrected between the 3th and 35th day after birth, 39 had a ventricular septal defect and/or associated anomalies. All operations were carried out under ECC and deep hypothermia. Myocardial function was recorded intraoperatively by using sonomicrometry. The data demonstrate that adaptation of the left ventricle to the new load conditions should be supported by drugs providing inotropic stimulation and afterload reduction. Mean follow-up time is 32.5 months, no rhythm problems have been recorded during that period, a few children revealed trivial pulmonary or aortic valve stenosis and/or incompetence. The switch operation permits good early results for newborns with TGA and intact septum and TGA with VSD. A decade has to pass in order to judge the long-term results.

Early Results with the Anatomical Correction of Transposition of the Great Arteries

From November 1984 to April 1991, 38 children underwent an arterial switch operation for transposition of the great arteries (TGA). In 24 infants (mean age 8 days) TGA with intact ventricular septum was present, in 14 patients (mean age 75 days) TGA was combined with a ventricular septal defect (VSD). There were 11 in-hospital deaths with an overall mortality of 29%, mainly due to technical problems. Whereas the group TGA + VSD showed a mortality rate of 50%, simple TGA and the subgroup simple TGA younger than 14 days had a mortality rate of 16.7% and 17.4%, respectively. Mortality was not influenced by coronary artery morphology and age. In simple TGA, the data presented suggest that this operation can be performed with good short-term clinical results. Most children are asymptomatic and without medication at a mean follow-up time of 2.5 years; but as there are pathological postoperative findings in echocardiography, the long-term benefit remains a matter of concern. Considerable perioperative problems are present in cases of TGA + VSD so surgical management is more differentiated, including other options.

Anatomic correction for transposition of the great arteries: first follow-up (38 patients).

Between April 1983 and October 1985, 38 consecutive patients with transposition of the great arteries (TGA) underwent anatomic correction. Ages ranged from 1 day to 284 weeks (mean 26.2 weeks). Simple TGA was present in 17 patients, 17 had an associated ventricular septal defect, and the remaining four had a Taussig-Bing anomaly. Hospital mortality was 2 of 38, with 1 late death. Follow-up time varied from 6 to 35 months. Postoperative cardiac catheterization was performed in 34 of the 36 early survivors. Right ventricular outflow tract obstruction with a systolic gradient greater than 20 mmHg was found in four. A residual left-to-right shunt was found in nine; Qp/Qs exceeded 2.0 in only one. In four, the pulmonary-to-systemic resistance ratio calculated was greater than 0.3. All 35 survivors are in excellent condition. Only one patient has slight aortic insufficiency. Most pre- and postoperative electrocardiographic abnormalities disappeared in due course. Echocardiography revealed normal left ventricular dimensions and fractional shortening. The aortic root diameter showed in almost all a value above the 95th percentile of normal. Postoperatively, the aortic root has grown parallel to, but above, the 95th percentile and as yet has shown no tendency to normalization.

Infundibular septal resection: Surgical anatomy of the superior approach

A technique for extensive resection of the infundibular septum through the superior transarterial approach is proposed. Infundibular septal resection facilitates intraventricular rerouting for anatomic correction of transposition of the great arteries with ventricular septal defect and double-outlet right ventricle. This technique also may be used to enlarge progressively obstructive but physiologically advantageous ventricular septal defects, for example, with tricuspid atresia. Through the superior transaortic or transpulmonary approach, the landmarks of the infundibular septum are the intercoronary commissure of the aortic valve and the septal commissure of the pulmonary valve, both of which are directly above the middle of the infundibular septum. With this exposure, the infundibular septum may then be resected easily and relatively completely and a large opening created immediately beneath the semilunar valves. The feasibility of infundibular septal resection by the superior approach was assessed post mortem in 25 cases of transposition of the great arteries with ventricular septal defect and in 20 autopsied cases of double-outlet right ventricle. This technique was subsequently applied successfully to enlarge the obstructive ventricular septal defect of a 2-year, 11-month-old girl with D-transposition of the great arteries. The advantages of the proposed technique include technical ease, relative completeness of infundibular septal resection, and the facilitation of intraventricular repair of transposition of the great arteries with ventricular septal defect and double-outlet right ventricle.

心室中隔欠損を併う完全大血管転位症に対する解剖学的根治術（Ｊａｔｅｎｅ手術Ｌｅｃｏｍｐｔｅ変法）

心室中隔欠損を併う完全大血管転位症に対する解剖学的根治術（Ｊａｔｅｎｅ手術Ｌｅｃｏｍｐｔｅ変法）

Surgical Implications of Early Branching of the Left Coronary Artery in Anatomic Correction of Transposition of the Great Arteries

Early branching of the left coronary artery (LCA) may become an additional operative challenge during coronary transfer in anatomic correction of transposition of the great arteries. An early branch of the LCA running in opposite transfer direction was present in 3 out of 25 patients who underwent anatomic correction. By excising a large cuff of aortic sinus wall around the ostium of the LCA enough length was gained for successful coronary transfer without kinking in 2 patients in whom the first branch was arising at the level of the origin of the circumflex artery. In the third patient with the first branch arising proximal to the origin of the circumflex artery an alternative surgical procedure seemed preferable. In such a coronary anomaly optimal visualization of the coronary branching pattern, possibly including selective coronary angiography, is advisable for better planning of the surgical technique.

Left ventricular shape and function one year or more after anatomic correction of transposition of the great arteries

Left ventricular shape and function one year or more after anatomic correction of transposition of the great arteries

Anatomic correction of transposition of the great arteries

Anatomic correction of transposition of the great arteries

Growth potential of the coronary, aortic and pulmonary anastomoses following anatomic correction of transposition of the great arteries

Growth potential of the coronary, aortic and pulmonary anastomoses following anatomic correction of transposition of the great arteries