Conal Septum Research Articles

The aortic translocation (Nikaidoh) procedure: Initial experience

Objective Midterm follow-up is analyzed after the aortic translocation (Nikaidoh) procedure, an alternative to the Rastelli procedure for ventriculoarterial discordance, ventricular septal defect, and pulmonary stenosis especially in cases with small or inlet VSD. Methods Seven patients underwent a Nikaidoh procedure at a median age of 3.3 years (0.9–9.3 years). The native aortic valve was translocated from the right to the left ventricular outflow tract by mobilization of the aortic root.Four patients with coronary transfer as the right coronary artery reimplanted as a button while the other three patients had no coronary transfer. The conal septum was divided in all patients. The right ventricular outflow tract was reconstructed with valved conduit. The median follow-up was 18 months (0.3–4 years). Left ventricular outflow tract obstruction and aortic insufficiency were assessed by echocardiography. Results There were no deaths. Right ventricular to Pulmonary artery conduit change were required in 2 patients (28.6%). No patient had any left ventricular outflow tract obstruction or aortic insufficiency more than mild. All patients are doing well at last follow up. Conclusion The Nikaidoh is a valid alternative to Rastelli or REV operations. It appears particularly indicated in patients with TGA,VSD and LV outflow obstruction with small or inlet VSD.

Pitfalls in Repair of Conotruncal Anomalies

Despite a wide anatomic diversity, the complete repair of all conotruncal anomalies includes two surgical steps. 1) An intracardiac tunnel is created to connect the left ventricle to one of the arterial orifices (usually the aortic, sometimes the pulmonary), through the conoventricular ventricular septal defect. Any conal septum should be resected to create a short, large, and straight tunnel. Abnormal insertions of the atrioventricular valves (tricuspid and mitral) on the conal septum should be preserved. "Intramural" residual ventricular septal defects must be avoided by anchoring the intracardiac patch directly to the arterial annulus. 2) To connect the right ventricle to the pulmonary artery, either an intracardiac or an extracardiac reconstruction is carried out, according to the distance between the tricuspid valve and the pulmonary orifice. When extracardiac reconstruction is indicated, it is usually performed without prosthetic conduit (with or without French maneuver, eventually using the left atrial appendage). In most patients, complete repair can be performed as a primary operation during infancy.

Surgical removal of a left ventricular myxoma in an infant

Left ventricular (LV) myxoma is particularly rare in children and has not been reported in infants. A five-month-old baby presented with a myxoma arising from the anterior, lateral, and superior aspect of the LV, causing severe left ventricular outflow tract obstruction. The LV was accessed through the conal septum after opening the right ventricular outflow. The child had transient complete heart block in the postoperative period. There was no recurrence of tumor at the nine-month follow-up.

Conal Septal Morphometrics Can Identify Higher Risk Neonates with Tetralogy of Fallot

Some neonates with tetralogy of Fallot (TOF) have rapid progression of right ventricular outflow tract obstruction, requiring early repair irrespective of Doppler gradient as measured in the neonatal period. The aim of this study was to test the hypothesis that infundibular morphology in neonates with TOF is associated with the occurrence of hypercyanotic spells and need for neonatal surgery. Fifty patients with TOF undergoing surgical repair from 2003 to 2009 were studied. Neonatal echocardiograms were retrospectively analyzed to measure conal septal angle (the angle between the conal septum and the horizontal plane passing through the center of the aortic valve in the parasternal short-axis view, with a larger angle denoting more anterocephalad deviation of conal septum), conal septal thickness and length, the degree of aortic dextroposition, and sizes and Z scores of the pulmonary annulus and the main and branch pulmonary arteries. Outcomes included the occurrence of hypercyanotic spells and the need for neonatal surgery. The median age at first echocardiogram was 2 days (range, 0-12 days). The median age at surgery was 94 days (range, 5-282 days); hypercyanotic spells occurred in 17 patients (34%), and nine (18%) underwent neonatal repair. The presence of a wider conal septal angle was significantly associated with the occurrence of hypercyanotic spells (59 ± 21° vs 48 ± 13°, P= .023) and the need for neonatal surgery (67 ± 13° vs 48± 16°, P= .004). The positive and negative predictive values of hypercyanotic spells for conal septal angles ≥60° were 64% and 78%, respectively. Importantly, Doppler right ventricular outflow tract gradient at initial echocardiography, degree of aortic dextroposition, and pulmonary or aortic valve size were not associated with these outcomes. A wider conal septal angle is associated with the occurrence of hypercyanotic spells and the need for neonatal surgery.

Natural Internal Banding in Adult Patients with a Large Ventricular Septal Defect and a Preserved Pulmonary Vascular System

Hypertrophied anomalous muscle bands (AMBs) in the right ventricular outflow tract (RVOT) may develop in the context of ventricular septal defects (VSDs) and limit persistent pulmonary overflow. In adult patients with a large VSD, persistent AMBs in the RVOT therefore can simulate the role of an externally placed pulmonary artery band. We termed such alterations natural internal bands (NIBs). Our goal was to establish the morphologic nature of the obstructive muscular lesions of the RVOT in patients with a large VSD. Patients who underwent operations for a large VSD in our center, which has a high volume of adult patients with congenital defects, were retrospectively reviewed, and the nature of the NIBs in these patients was documented. All patients underwent transthoracic echocardiography and cardiac catheterization evaluations preoperatively and at postoperative month 3. Histopathologic examination of the AMBs was performed. Of 96 adult patients who underwent operations for a large isolated VSD (mean defect size, 16.9 ± 3.5 mm), 16 patients had a hemodynamically significant NIB. Two different patterns of obstruction were found. Ten of the 16 patients revealed an os infundibulum morphology, and 6 patients revealed systolic bulging of the conal septum. Four of the patients with os infundibulum also had classic tetralogy-type septal malalignment. The mean peak systolic gradient on the RVOT was 56.5 ± 17.2 mm Hg and 53.6 ± 12.3 mm Hg in the patients with os infundibulum and in the patients with systolic bulging of the conal septum, respectively. Surgical repair of the VSD was completed successfully in all patients. Resection of the os infundibulum was performed concomitantly in patients with os infundibulum. At the third postoperative month, the mean peak systolic gradient was 16.8 ± 3.5 mm Hg in patients with os infundibulum and 26 ± 5.9 mm Hg (range, 20-35 mm Hg) in patients with systolic septal bulging. Some mechanisms in adult type VSDs are essential for protecting the pulmonary vasculature. We tried to review these protective mechanisms: hypertrophied AMBs and NIBs.

Realignment of the ventricular septum using partial direct closure of the ventricular septal defect in Tetralogy of Fallot

The aim is to describe our technique of partial direct closure of the ventricular septal defect (VSD) in Tetralogy of Fallot (TOF), and assess its influence on the realignment and remodeling of the left ventricular outflow tract. Between 2004 and 2010, 32 non-consecutive patients with TOF underwent a direct or partial direct closure of VSD. Median age and weight were 5.2 months and 6.7 kg, respectively. An approach through the right atrium was used in 30 patients and through the infundibulum in two patients. The conal septum was mobilized by transecting the hypertrophic trabeculae to facilitate the approximation of the VSD. The membranous part of the VSD was closed (in the later part of the series) with a small xenopericardial patch to avoid tension on the suture line traversing the area of risk to the bundle of His. Follow-up was complete, with a median duration of 46.9 (range 12-75.3) months. The VSD could be closed successfully in all patients. A residual VSD was partly responsible for one early postoperative re-operation. There were no early or late deaths. At follow-up, all patients were in sinus rhythm. Three patients showed a small residual VSD. Thirty patients had none, one showed trivial, and one had mild aortic regurgitation. The left ventricular outflow showed a good realignment of the ventricular septum in all the patients. Partial direct closure of the VSD corrects the primary defect in TOF, that is, the malalignment of the septum. It results in a straight, wide open left ventricular outflow tract and brings better support to the aortic root.

Right ventricular outflow repair: the aortic autograft technique procures the best late results in the transposition complex☆

After treatment of transposition of the great arteries (TGA), ventricular septal defect (VSD), pulmonary stenosis, or atresia by various surgical procedures, two main problems led to reoperation: RV-PA conduit or connection stenosis and subaortic stenosis. We report here our mid- and long-term experience of a technique described in 1997 using a segment of aortic autograft as a RV-PA conduit. Between 1993 and 2005, 25 patients with TGA, VSD, PS, or atresia were corrected with a technique using an intra-ventricular rerouting with conal septum resection (as in reconstruction-endo-ventriculaire (REV)) and interposition of tubular segment of autograft aorta between RV and PA without Lecompte maneuver (as in Rastelli), using in some cases an additional monocusp patch. The patient's age at correction ranged from 2.5 months to 11 years (mean 2.2 years); seven patients were under 1 year and 13 had a previous shunt procedure. Patients were regularly followed by two-dimensional (2D) annual echocardiogram, occasionally by catheterization and more recently by MNR. There was one postoperative death essentially due to RV failure. There was one late death after 15 years. There were 23 long-term survivors with a mean follow-up of 12.8 years. All patients were in class I category and all of them were in sinus rhythm. Three of them needed a reoperation at 4, 5, and 6 years for subaortic stenosis and one of them with abnormal chordae in the left ventricle (LV) outflow, Only one patient needed a reoperation for RV-PA stenosis, 13 years after correction done at age 2.5 months, the autograft tissue not being implied and found normal at histology. Mean RV pressure by echo at last follow-up was 41 mm Hg. Ten patients exhibit a mild-to-moderate pulmonary regurgitation. Freedom from reoperation for RV-PA obstruction is 90% at 10 and 15 years. Compared with all other techniques (Rastelli, REV, and Nikaidoh) our autograft technique provides the best-reported outcome for RV-PA outflow freedom from reoperation, the aortic segment employed being a living tissue susceptible to growth. However, it remains most often a long-term valveless procedure and does not avoid occasional unexpected LV-AO stenosis.

Right Coronary Cusp Prolapse Resembling Subpulmonic Stenosis in an Old Adult Patient with Ventricular Septal Defect

Ventricular septal defect (VSD) can be associated with various complications such as aortic regurgitation (AR). AR in VSD come from a deficiency or hypoplasia of the conal septum which leads to abnormal apposition in diastole and prolapse of the poorly supported noncoronary or right coronary cusp through the VSD into the right ventricle resembling subpulmonic stenosis and subsequently results in distortion of the aortic valve and progressive AR. AR often increases in severity with age and it indicates a worse prognosis. Therefore, appropriate timing of surgical repair in progressive AR in VSD might be important. Until now, many earlier experiences about surgical repair of AR complicating VSD were on adolescents or young adults. We reported a case of AR in 48-year-old male patient with right coronary cusp prolapse complicating the subarterial type of VSD which was properly assessed by echocardiography and was successfully treated with surgical repair. Right coronary cusp or noncoronary cusp prolapse should be suspected in AR complicating VSD through proper echocardiographic assessment and the surgical repair on VSD and distorted aortic valve should be considered in the old patient, as well as the young.

Invited Commentary

This article from the Fuwai Hospital of Beijing is a report of a new operation: the double root translocation applied to double-outlet right ventricle with noncommitted ventricular septal defect (DORV-nc-VSD) and Taussig-Bing; both with pulmonary stenosis (PS) [1]. The aortic translocation is considered today by many centers as the optimal technique for repair of transposition of the great arteries, ventricular septal defect and pulmonary stenosis (TGA-VSD-PS). The double root translocation technique removes en bloc the two aortopulmonary roots and the conal septum and is emerging as an interesting new technique.

Pulmonary Vascular Protective Mechanisms in Adult Patients with an Isolated Large Ventricular Septal Defect: A 21‐Year Experience

Ventricular septal defects (VSDs) are one of the most common congenital heart defects in adults. In adult patients with an anatomically large VSD and relatively preserved pulmonary vascular system, several pulmonary flow-limiting cardiac morphologic alterations (PFMA) are encountered. Ninety-eight male patients (mean age 22.5 +/- 2 years) operated for an anatomically large VSD in our institution were retrospectively reviewed. PFMA in patients with an anatomically large but functionally mild-to-moderate VSD (when ratio of pulmonary to systemic flow (Q(p)/Q(s)) < 2.2 and ratio of pulmonary to systemic vascular resistance (R(p)/R(s)) < 0.3) were recorded. Thirty patients (31.2%) revealed a mild-to-moderate VSD in functional severity. Five PFMA were encountered in these patients: (1) ostium (os) infundibulum (n = 10, 33.3%), (2) aneurysm of the membranous septum (AMS) (n = 10, 33.3%), (3) systolic bulging of the conal septum toward the right ventricular outflow tract (n = 6, 20%), (4) prolapse of the aortic cusps (n = 2, 6.7%), and (5) attachment of the tricuspid septal leaflet to the septal crest (n = 2, 6.7%). Double-chambered right ventricle was encountered in four patients with os infundibulum and classic tetralogy-type septal malalignment in one patient with aortic cusp prolapse. Concurrent to VSD repair, resection of the os infundibulum and the AMS and aortic valve repair were performed. Presence of a large VSD and relatively preserved pulmonary vascular system in adults is associated with several PFMA. Preoperative awareness and concurrent surgical treatment of these alterations seem to be crucial to improve the expected benefit of surgical repair of VSD in this subgroup of the patients.

Left ventricular outflow tract obstruction after arterial switch operation

Postoperative left ventricular outflow tract obstruction (LVOTO) after arterial switch operation (ASO) is rare. In this retrospective study, we reviewed the cases of 10 patients with LVOTOs post-ASO and analyzed the options used for the LVOTOs corrections and the patients' outcomes. From December 1982 to December 2006, 1689 consecutive ASO were performed. Ten patients presented with postoperative LVOTOs (0.59% of all ASO and 7.62% of ASO for Taussig-Bing anomaly (TBA)) leading to reoperations. Before ASO they presented with significant subaortic gradients (n=4) or predisposing anatomical features (n=9) such as: conal septum malalignment (7/9), abnormal tricuspid cords insertions (4/9), muscular bundle hypertrophy (3/9) and mitral accessory tissue (2/9). No patient was lost in the follow-up: 117+/-33 months. Subaortic gradients had developed between 5 months and 14 years after ASO (mean 41+/-35 months) leading to reoperations. Most LVOTOs post-ASO were due to fibrotic membranes or fibro-muscular hypertrophy, removed at first reoperation. After their first reoperations, seven patients (70%) had non-significant or low gradients and were not reoperated for LVOTO. Three patients underwent iterative surgical procedures for LVOTOs leading to two aortic valve replacements associated with LVOTO release or Konno procedure. Postoperative LVOTO after ASO is rare but happens more frequently in TBA. Most of them can benefit from resections of subaortic obstacles or septal plasties. In more complex cases iterative surgical procedures may lead to complications such as block or severe aortic valve regurgitation.

Echocardiographic Evaluation and Surgical Implications of Common Atrioventricular Canal Defects With Absent or Diminutive Ostium Primum Defect

Common atrioventricular canal defects without ostium primum defects are rare, and their accurate identification has important surgical implications. Retrospective echocardiographic database review identified subjects with common atrioventricular canal defects with absent or diminutive ostium primum defects. Surgical reports and initial and postoperative echocardiograms were reviewed to identify the imaging planes necessary to characterize this anomaly and the surgical challenges imposed by the diagnosis. Fourteen subjects were identified (93% with trisomy 21) with either absent (n = 6) or diminutive (n = 8) ostium primum defects. Malaligned conal septum was present in 50% of subjects with absent primum defects and 12.5% of subjects with diminutive defects. Immediate or long-term complications of the 11 postoperative patients included atrioventricular block (n = 4) and moderate (n = 5) or severe (n = 3) mitral regurgitation. In conclusion, echocardiographic features for the identification of common atrioventricular canal defects with absent or diminutive ostium primum defects are described. Surgical challenges involve attaining adequate exposure of the mitral component and achieving mitral valve competence.

Modified Konno operation for diffuse subaortic stenosis

The modified Konno operation is designed to provide relief of diffuse subaortic stenosis, while preserving the native aortic valve. The aorta and the right ventricular infundibulum are opened. The upper part of the subaortic stenosis is incised through the aortic orifice. The conal septum is incised and the septotomy is extended across the stenotic area. The obstructive tissue is removed (mainly from the left-handed rim of the septotomy) and the conal septum is enlarged with a prosthetic patch. The aorta is closed and the right ventricular infundibulum is enlarged. Early and late mortality rates are low. Potential morbidity (complete heart block, residual ventricular septal defect, iatrogenic aortic insufficiency, right ventricular outflow tract obstruction) should be minimized by a careful surgical technique. The modified Konno operation is indicated in patients with diffuse subaortic stenosis and a normal aortic orifice; this includes patients with severe forms of hypertrophic obstructive cardiomyopathy and children with tunnel subaortic stenosis and a normal aortic orifice; the modified Konno procedure provides long-lasting relief of the obstruction. In patients with tunnel stenosis and a borderline-sized aortic annulus, residual obstruction may develop at the valvar level and need reoperation; the modified Konno operation can, however, delay aortic valve replacement.

Adult Congenital Heart Disease

It has variably been estimated that between 800 000 and 1 million patients with congenital heart disease are now adults and that by 2010 more patients older than 16 years will undergo surgery for congenital heart disease than those younger than 16 years.1 This review will focus on the clinical aspects of identifying and caring for the portion of the unique population that have right ventricular (RV) outflow tract lesions. The left ventricle (LV) and RV both have inlet, apical, and outlet portions, although they differ considerably.2 The inlet of the RV includes the tricuspid valve, and it is separated from the pulmonary valve (PV) by the crista supraventricularis. This structure results in the PV being raised upward. The apical portion of the RV has coarse trabeculations. As shown in Figure 1, the septum is home to a large septomarginal (septal) trabeculation that divides into the anterior and posterior limbs in the outflow tract. A series of septoparietal trabeculations arise along the free wall. The crista supraventricularis inserts between these limbs and is made up of 3 components: the muscular outlet septum, the ventriculoinfundibular fold, and the inner curvature of the RV.3 The small part that separates the RV and LV cavities is the outlet or conal septum. A loop including the septal trabeculation, the moderator band, septoparietal trabeculations, and the outlet septum can be conceptualized as circling the RV outflow tract. The PV is supported by the circular muscular infundibulum rising outside the RV proper. Abnormalities involving the RV outflow tract involve malpositioning of 1 or more of these structures. Figure 1. The anatomy of the RV outflow tract.2 There is a large septomarginal (septal) trabeculation that divides into 2 limbs. The anterior limb supports the leaflets of the PV, and the posterior limb …

Pulmonary and aortic root translocation in the management of transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction

The Nikaidoh procedure, as an alternative to the Rastelli operation for dealing with transposition of the great arteries (TGA) with ventricular septal defect (VSD) and pulmonary stenosis (PS), could obtain a superior anatomic result. 1,2 However, the extracardiac conduit is unable to grow and is inevitably calcified; thereafter, the patients required reoperation. We report our experience with a novel modification in which the native pulmonary valve was preserved to address these problems.

Double-outlet right ventricle with left malposition of the great arteries and total anomalous pulmonary venous connection

The patient was diagnosed with double-outlet right ventricle with left malposition of the great arteries, total anomalous pulmonary venous connection, and pulmonary stenosis at 2 months of age. Because the progression of pulmonary venous obstruction was suspected at 2 years of age, the patient was catheterized and underwent a definitive repair. The patient had a right aortic arch and left juxtaposition of the atrial appendages; the intraventricular anatomy exhibits malalignment between the conal septum and the muscular intraventricular septum, and the conal septum is well developed and dextroposed, resulting in pulmonary obstruction and multiple ventricular septal defects (VSDs). Because a supracardiac type (Darling's type Ib) of total anomalous pulmonary venous connection was also combined with such an anomaly, total correction consisted of an anastomosis of the left atrium and the common pulmonary vein, creation of an intraventricular tunnel, direct closures of muscular VSDs, pulmonary valvotomy, and infundibular resection. To our knowledge, this is the first description of the successful surgical correction of this type of anomaly in one stage.

Arrhythmias in Adult Patients With Congenital Heart Disease

By the time patients with congenital heart disease (CHD) reach adolescence and early adulthood, rhythm status has often become an active issue, if not the central issue, in their cardiac management. For some, arrhythmias are intrinsic to the structural malformation itself, as is the case with Wolff-Parkinson-White syndrome in the setting of Ebstein’s anomaly, or atrioventricular (AV) block in the setting of “congenitally corrected” transposition of the great arteries (L-TGA). For most other CHD patients, arrhythmias represent an acquired condition related to the unique myocardial substrate created by surgical scars in conjunction with cyanosis and abnormal pressure/volume loads of long duration. This review will attempt to address the major rhythm difficulties faced by adults with CHD, concentrating on electrophysiological features that distinguish CHD from more conventional forms of adult heart disease. A listing of specific arrhythmias and commonly associated congenital defects is provided in Table 1 to serve as an outline for the discussion. View this table: TABLE 1. Specific Arrhythmias and Associated Defects in Adults With Congenital Heart Disease As of 2001, there were estimated to be 800 000 adults with CHD living in the United States,1 a number that has grown steadily as more survivors of childhood surgery reach maturity. Of these, roughly 45% are considered to have mild forms of CHD (eg, atrial septal defect, valvar pulmonary stenosis), 40% are classified as having moderate disease (eg, tetralogy of Fallot, Ebstein’s anomaly), and 15% are considered to have complex disease (eg, single ventricle, transposition of the great arteries). Although arrhythmias can develop within any of the 3 subgroups, the incidence is highest for patients in the moderate and severe categories. Tetralogy of Fallot is an instructive example of moderate CHD with a large arrhythmia burden. As many as one third of patients with repaired tetralogy develop symptomatic atrial tachycardias by …

The aortic translocation (Nikaidoh) procedure: Midterm results superior to the Rastelli procedure

Midterm follow-up is analyzed after the aortic translocation (Nikaidoh) procedure, an alternative to the Rastelli procedure for ventriculoarterial discordance, ventricular septal defect, and pulmonary stenosis. Nineteen patients underwent a Nikaidoh procedure at a median age of 3.3 years (0.9-9.3 years). The native aortic valve was translocated from the right to the left ventricular outflow tract by full (n = 6) or partial (n = 13) mobilization of the aortic root. Seven patients with partial mobilization had the right coronary artery reimplanted as a button. The conal septum was divided in 13 patients. The right ventricular outflow tract was reconstructed with either a homograft (n = 4) or a right ventricular outflow tract patch (n = 15). The median follow-up was 11.4 years (0.1-23 years), and the median age at follow-up was 17.4 years (1-30 years). Left ventricular outflow tract obstruction and aortic insufficiency were assessed by echocardiography. One patient died of right coronary arterial ischemia. All remaining patients (95%) survived. The median survival was 13.6 years (longest, 23.0 years). Seven right ventricular outflow tract reoperations were required in 5 patients (6 with obstruction and 1 with pulmonary insufficiency). No reoperations have been performed on the left ventricular outflow tract or aortic valve. No patient had any left ventricular outflow tract obstruction or aortic insufficiency more than mild (mild in 9 patients, trivial in 3 patients, and absent in 6 patients). Midterm actuarial survival was 95% after the Nikaidoh procedure. Reintervention for the right ventricular outflow tract is more common when valved conduits are used versus valveless reconstruction; however, the Nikaidoh procedure provides complete freedom from important aortic insufficiency and left ventricular outflow tract obstruction.

子牛に認められた肺動脈閉鎖を伴う大・肺動脈窓の1例

Aortopulmonary window was observed in a five-day-old male Horstein calf. The aortic and pulmonary valves were completely separated by the conus septum, and the distal part of the pulmonary trunk was atretic and disappeared. The heart was associated with atrial and ventricular septal defects, double outlet right ventricle and single coronary artery.

Procedimento de Lecompte para a correção de transposição das grandes artérias, associada à comunicação interventricular e obstrução de via de saída do ventrículo esquerdo

OBJETIVO: Avaliar o procedimento de Lecompte para a correção da transposição das grandes artérias associada à comunicação interventricular e obstrução da via de saída do ventrículo esquerdo (TGA, CIV e OVSVE) e apresentar os resultados no período pós-operatório intermediário e tardio. MÉTODO: Entre fevereiro de 1994 e julho de 2005, sete pacientes, com idade de 2 a 8 anos (mediana -M-: 3,0), portadores de TGA, CIV e OVSVE, foram submetidos a tratamento cirúrgico corretivo. Em seis casos, foi utilizado o procedimento de Lecompte. Esta técnica consiste na abordagem por ventriculotomia direita, ressecção ampla do septo conal e construção de um túnel ventricular conectando o ventrículo esquerdo à aorta; o caso restante apresentava obstrução da prótese valvulada implantada entre o ventrículo direito e a artéria pulmonar (VD-AP) e falência do VD e foi submetido à conversão no procedimento de Lecompte. RESULTADOS: Os tempos de CEC variaram entre 105 e 194 min (M: 130) e os tempos de anoxia entre 65 e 90 min (M: 78). Houve um óbito no pós-operatório imediato devido a coagulopatia, seguido de insuficiência ventricular direita. Os seis pacientes sobreviventes receberam alta hospitalar no período de 5 a 30 dias (M: 11) e permaneceram em acompanhamento entre 12 a 144 meses (M: 73,6). CONCLUSÃO: O procedimento de Lecompte teve como vantagens: 1 - Indicação cirúrgica em pacientes com menor faixa etária; 2 - Baixa morbi-mortalidade; 3 - Expectativa de acompanhamento a longo prazo, sem reoperação; 4 - Possibilidade de converter o procedimento de Rastelli em Lecompte.