Pulmonary Root Translocation Research Articles

Early Experience With Pulmonary Root Translocation in Transposition of the Great Arteries With Left Ventricular Outflow Tract Obstruction.

The optimal surgical management of patients with transposition of the great arteries (TGA), ventricular septal defect (VSD), and left ventricular outflow tract obstruction (LVOTO) is debatable. This is our initial experience with pulmonary root translocation (PRT), a technique that aims to preserve the pulmonary valve function. From July 2012 to October 2019, 16 patients underwent anatomical repair for TGA, VSD, and LVOTO. The median age was 12 months (range: 7 months to 13 years), and the median weight was 7.75 kg (range: 5.6-29.5 kg). Thirteen patients had a diagnosis of d-TGA and three had congenitally corrected transposition of the great arteries (cc-TGA). The surgical technique involved PRT from the left ventricle (LV) to the right ventricle and routing the LV to the aorta. The left ventricular outflow tract orifice resulting from the pulmonary root extraction was closed with a pericardial patch. In patients with cc-TGA, an atrial switch operation was added. A bidirectional Glenn was necessary in four patients with a long LV to aorta tunnel. One patient required a transannular patch to reconstruct the right ventricular outflow tract (RVOT). The median follow-up was 27 months. There was one hospital death due to residual mitral regurgitation. One patient died at home four months after hospital discharge. The remaining patients are doing well with adequate RVOT function and no valve regurgitation. Complete correction of TGA, VSD, and LVOTO using PRT was achieved with acceptable risk in patients with pliable and nondysplastic pulmonary valve. The translocated pulmonary root performed well in this short follow-up.

Aortic root translocation: the Bex-Nikaidoh procedure.

Patients with transposition of the great arteries, ventricular septal defect, and left ventricular outflow tract obstruction are managed by various techniques. Traditional techniques include intracardiac baffling with a right ventricle to pulmonary artery conduit (Rastelli procedure) and the "reparation a l'etage ventriculaire" (REV) procedure. However, other techniques such as aortic root translocation (Bex-Nikaidoh procedure), pulmonary root translocation, and double root translocation are equivalent or in fact provide better results than the traditional techniques. In this review we will have a detailed discussion about aortic root translocation which allows a more normal and anatomically aligned left ventricular outflow tract. However, the operation is technically demanding, and coronary translocation remains one of the major challenges for successful root translocation.

Double-root transfer and the half-turned truncal switch.

Transposition of great arteries (TGA) or double-outlet right ventricle (DORV) with ventricular septal defect (VSD) and pulmonary stenosis (PS) is a complex congenital cardiac malformation, which can be treated by both univentricular and biventricular pathways. Biventricular repair includes Rastelli operation, reparation a l'etage ventriculaire (REV), pulmonary root translocation, and Nikaidoh procedures. Double-root translocation (DRT) technique and half-turned truncal switch technique (HTTS) are being considered as useful alternatives. In this review, we will see in detail about DRT and HTTS.

Bi-ventricular repair of double outlet left ventricle: Experience and review of the literature.

Double-outlet left ventricle (DOLV) is a rare congenital cardiac anomaly. The aorta and the main pulmonary arterial trunk arises predominantly from the left ventricle and is associated with a malaligned ventricular septal defect, various degrees of hypoplasia of the right ventricle, and presence, or absence of pulmonary stenosis. Bi-ventricular repair is the preferred treatment option whenever possible. Multiple techniques for bi-ventricular repair have been described. The best option for DOLV correction is by translocating the pulmonary root from the left ventricle to the right ventricle. In this series, we report four patients who underwent biventricular repair of DOLV with excellent outcomes. This is a retrospective study of four patients who underwent surgical correction of DOLV between January 2014 and December 2018. We collected all patient details from the institute patient record system. Echocardiographic data were obtained from the records. Intraoperative charts were reviewed for further information on the surgical procedure and cardiopulmonary bypass. Postoperative data included survival, functional status, and followup echocardiography. Of the four children, three underwent pulmonary root translocation, and one child underwent a Reparation al etage Ventriculaire (REV) procedure. There was no mortality in our series, and all children are in a stable clinical condition in the recent follow-up, and no re-operations or interventions were required following primary surgical correction. DOLV is anatomically and surgically a challenging subset. Pulmonary root translocation in this anatomy is technically challenging but safe and superior option when compared to other alternative surgical procedures. Pulmonary root translocation can be performed with excellent results, even in infants.

The science and art of aortic and/or pulmonary root translocation

This review aims to present and compare different surgical techniques of root translocation of the great arteries except the Ross procedure. The historical aspects, technical considerations, and results are briefly elucidated.

Pulmonary Root Translocation with the Lecompte Maneuver: For Transposition of the Great Arteries with Ventricular Septal Defect and Pulmonary Stenosis

A five-month-old boy who had undergone previously transcatheter balloon atrioseptostomy at 3 days of age for complete transposition of the great arteries with ventricular septal defect and pulmonary stenosis underwent pulmonary root translocation with the Lecompte maneuver. This operation has the advantages of maintaining pulmonary valve function, preserving the capacity for growth, and avoiding problems inherent to the right ventricular to pulmonary artery conduit. This patient progressed well for 9 months postoperatively and we report this case of pulmonary root translocation with the Lecompte maneuver.

Root translocation in congenitally corrected transposition of the great arteries with ventricular septal defect and pulmonary stenosis, and other lesions.

The pulmonary root translocation (PRT) procedure has been used to correct ventriculoarterial discordance or malposition of great arteries since 1994. It was part of the surgical repair of 62 consecutive patients presenting with congenitally corrected transposition of the great arteries (CCTGA) with ventricular septal defect (VSD) and pulmonary stenosis (PS), or other complex congenital heart disease with malposition of the great arteries, VSD, and PS. PRT was performed as follows: removal of the pulmonary artery (PA) with the pulmonary valve from its abnormal position, closure of the consequent hole with an autologous pericardial patch, resection of some conal septum, creation of an intraventricular tunnel connecting the left ventricle to the aorta, and construction of a new right ventricular outflow tract using the translocated PA. In patients presenting with important pulmonary valve stenosis, the pulmonary artery was enlarged with a monocusp valve pericardial patch. The Senning procedure was used with some modification to complete the anatomical repair in CCTGA patients. Overall in-hospital and long-term mortality were 4.8% and 3.4%, respectively. PRT appears to be a good surgical alternative for patients presenting with CCTGA with VSD and PS, and other lesions involving malposition of the great arteries, VSD, and PS.

Pulmonary Root Translocation for Anatomical Repair of Congenitally Corrected Transposition of the Great Arteries

Pulmonary root translocation (PRT) was used to correct ventriculoarterial discordance as part of anatomical repair for congenitally corrected transposition of the great arteries, ventricular septal defect (VSD) and pulmonary stenosis (PS). The Senning procedure was used for completion of the anatomical repair. From March 2004 to June 2014, ten consecutive patients were operated. There was no hospital and one patient died 5 years after the surgical repair. In the postoperative period, control echocardiogram showed no obstruction in the systemic and pulmonary venous return. Also, neither LVOT nor significant RVOT obstruction was found in any patient. Our initial results suggest that pulmonary root translocation is a good option for correcting ventriculoarterial discordance in the anatomical repair of CCTGA with VSD and LVOTO.

The Effect of Pulmonary Root Translocation on the Left Ventricular Outflow Tract

We report the effect of pulmonary root translocation onthe left ventricular outflow tract. A double switch operation with pulmonary root translocation was performed in a 6-year-old boy whose diagnosis was dextrocardia, congenitally corrected transposition of the great arteries, ventricular septal defect, and pulmonary stenosis. Postoperative magnetic resonance imaging showed more natural left ventricular outflow than preoperatively (19 mm vs 22 mm in length between the top of the interventricular septum and the aortic valve). This technique does not require coronary transfer and enables preservation of the aortic root structure. The long-term results, including left ventricular outflow tract morphology, should be evaluated.

Pulmonary root translocation in malposition of great arteries repair allows right ventricular outflow tract growth

Optimal surgical treatment of patients with transposition of the great arteries (TGA), ventricular septal defect (VSD), and pulmonary stenosis (PS) remains a matter of debate. This study evaluated the clinical outcome and right ventricle outflow tract performance in the long-term follow-up of patients subjected to pulmonary root translocation (PRT) as part of their surgical repair. From April 1994 to December 2010, we operated on 44 consecutive patients (median age, 11 months). All had malposition of the great arteries as follows: TGA with VSD and PS (n = 33); double-outlet right ventricle with subpulmonary VSD (n = 7); double-outlet right ventricle with atrioventricular septal defect (n = 1); and congenitally corrected TGA with VSD and PS (n = 3). The surgical technique consisted of PRT from the left ventricle to the right ventricle after construction of an intraventricular tunnel that diverted blood flow from the left ventricle to the aorta. The mean follow-up time was 72 ± 52.1 months. There were 3 (6.8%) early deaths and 1 (2.3%) late death. Kaplan-Meier survival was 92.8% and reintervention-free survival was 82.9% at 12 years. Repeat echocardiographic data showed nonlinear growth of the pulmonary root and good performance of the valve at 10 years. Only 4 patients required reinterventions owing to right ventricular outflow tract problems. PRT is a good surgical alternative for treatment of patients with TGA complexes, VSD, and PS, with acceptable operative risk, high long-term survivals, and few reinterventions. Most patients had adequate pulmonary root growth and performance.

Nova técnica: translocação aórtica e pulmonar com preservação da valva pulmonar

We applied successfully, a new surgical technique, in two children with transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction, that utilized aortic translocation with the aortic valve and the coronary arteries to the left ventricle, after correction of left outflow tract obstruction and correction of the ventricular septal defect, associated to pulmonary root translocation to the right ventricle, conserving integrally the pulmonary valve.

Double-outlet left ventricle: Diagnosis and management

Double-outlet left ventricle (DOLV) is a rare congenital cardiac malformation in which both great arteries originate entirely or predominantly from the morphologic left ventricle. DOLV occurs most commonly in the form of atrial situs solitus with atrioventricular (AV) concordance. Ventricular septal defect (VSD) is most commonly subaortic, and 90% of these patients have associated pulmonary stenosis. In most cases, there is a right anterior position of the aorta relative to the pulmonary artery. Most patients with DOLV will have pulmonary outflow obstruction and present soon after birth with cyanosis. DOLV with two well-developed ventricles is conventionally treated surgically by VSD closure, closure of the native left ventricle-to-pulmonary outflow, and placement of a right ventricle-to-pulmonary artery extracardiac conduit. However, pulmonary root translocation may be used as an alternative to biventricular repair of DOLV. Patients with DOLV and functionally single-ventricle or AV valve atresia will require a Fontan procedure.

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.

Pulmonary Root Translocation for Repair of Taussig-Bing Anomaly with Interrupted Arch

Anterior translocation of the pulmonary root was used as a new approach to the staged repair of Taussig-Bing anomaly with an interrupted aortic arch. It was performed to construct the right ventricle outflow tract with intraventricular baffling of the left ventricle to the aorta as the second stage operation after repair of the interrupted arch and pulmonary artery banding. This technique allows minimization of pulmonary regurgitation and has the major theoretical advantage for growth potential, which could diminish the need for reoperation.

Late results of pulmonary root translocation in the correction of transposition of the great arteries

OBJECTIVE: The purpose of this study was to evaluate the late follow-up of pulmonary root translocation, a technique that aims to avoid complications and the need of reoperations related to the Rastelli procedure, in the repair of ventriculo-arterial connection anomalies associated to pulmonary stenosis and ventricular septal defect. METHODS: Five patients, ranging from two months to three years of age, were submitted to anterior pulmonary root translocation, from April 1994 to July 1999. The surgical technique consisted of pulmonary root removal from the left ventricle and its connection to the right ventricle, after patch diversion of the blood flow from the left ventricle to the aorta, through the ventricular septal defect. The construction of the right ventricle outflow tract was completed with autologous pericardium. RESULTS: There were neither early nor late deaths. There was no need for re-intervention. The late clinical and echocardiographic follow-ups showed some growth of the pulmonary root, with no clinically significant transpulmonary valve gradient (zero to 41 mmHg) and all patients were asymptomatic. CONCLUSION: Pulmonary root translocation showed to be efficient in the repair of ventriculo-arterial connection anomalies, with ventricular septal defect and pulmonary stenosis, and it was employed even in small children, with good early and long-term results, without the need for late reoperations in this small group of patients.

Pulmonary root translocation for biventricular repair of double-outlet left ventricle

Double-outlet left ventricle is conventionally repaired with an extracardiac conduit when pulmonary stenosis is present. We report the use of pulmonary root translocation to the right ventricle to construct the posterior wall with autologous tissue and a porcine pericardial monocusp ventricular outflow patch anteriorly for 2 patients with double-outlet left ventricle. This technique allows minimization of pulmonary insufficiency, avoids coronary artery ligation with infundibulotomy, and has a major theoretical advantage for growth potential.

Pulmonary root translocation in transposition of great arteries repair

Anterior pulmonary root translocation is used as a new approach for anatomic repair of transposition complexes with ventricular septal defect and pulmonary stenosis. It is performed to construct the right ventricle outflow tract, after patch diversion of left ventricle to aorta. Since 1994, 3 infants underwent this procedure. The preliminary results indicate some growth of the pulmonary root and suggest that this technique could diminish reoperations in this group of patients.