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

2021 ◽  
Vol 12 (2) ◽  
pp. 197-203
Author(s):  
Anil Kumar Dharmapuram ◽  
Nagarajan Ramadoss ◽  
Vejendla Goutami ◽  
Sudeep Verma ◽  
Shantanu Pande
Keyword(s):  
Left Ventricular Outflow Tract ◽  
Pulmonary Valve ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Hospital Death ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow ◽  
The Right

Background: 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. Methods: 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). Results: 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. Conclusions: 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.

The Nikaidoh procedure for complex transposition of the great arteries: short-term follow-up

2016 ◽  
Vol 27 (5) ◽  
pp. 945-950
Author(s):  
Guillermo Ventosa-Fernández ◽  
Carolina Pérez-Negueruela ◽  
Javier Mayol ◽  
Marina Paradela ◽  
José M. Caffarena-Calvar
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow ◽  
Complex Forms

AbstractBackgroundThe surgical treatment for complex forms ofd-transposition of the great arteries associated with ventricular septal defect and left ventricular outflow tract obstruction remains controversial. In this study, we describe the classical surgical options – namely, the Rastelli procedure and the “réparation à l’étage ventriculaire” – and present our experience with the modified Nikaidoh procedure with early and short-term follow-up results.MethodsBetween 2007 and 2014, four patients withd-transposition of the great arteries associated with ventricular septal defect and left ventricular outflow tract obstruction underwent surgical repair at our institution by means of a modified Nikaidoh procedure.ResultsWith a mean follow-up of 4.5 years, survival was 100%, and none of the patients required re-intervention or mechanical circulatory support. There was no recurrence of left ventricular outflow tract obstruction and no aortic valve regurgitation classified as more than mild. Left ventricular function was preserved.ConclusionsAortic translocation with the modified Nikaidoh procedure is a safe and effective surgical treatment for certain complex forms of transposition of the great arteries, particularly those associated with ventricular septal defect and left ventricular outflow tract obstruction. It is associated with less need for re-intervention and better morbidity and mortality results in the short- and mid-term follow-up, when compared with the classical alternatives such as the Rastelli procedure.

scholarly journals Surgical Options for Transposition of the Great Arteries With Ventricular Septal Defect and Left Ventricular Outflow Tract Obstruction: Evolution and Functional Impact

2020 ◽  
Vol 23 (6) ◽  
pp. E770-E773
Author(s):  
Alsayed Salem
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow ◽  
Surgical Options ◽  
The Right

Surgery for D-transposition of the great arteries, ventricular septal defect and left ventricular outflow tract obstruction has continuously evolved to achieve optimal hemodynamic performance across the right and left ventricular outflow tracts, include predominantly native tissues, and preserve pulmonary valve function. Classically, three types of repair are applied: Rastelli, REV, and translocation procedures. The concept of translocation remains more radical and exposed to many modifications. Its extensive reconstructive nature extends its application to similar lesions with discordant ventriculo-arterial connection. We tried to compare the values and limitations of these surgical options, emphasizing how a more anatomical repair could impact the functional outcome.

Hybrid stenting for left ventricular outflow tract obstruction in congenitally corrected transposition of the great arteries

2016 ◽  
Vol 27 (5) ◽  
pp. 978-980
Author(s):  
Steven L. Rathgeber ◽  
Sanjiv K. Gandhi ◽  
Kevin C. Harris
Keyword(s):  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow ◽  
Defect Repair ◽  
Congenitally Corrected Transposition ◽  
Corrected Transposition

AbstractCongenitally corrected transposition of the great arteries is commonly associated with left ventricular outflow tract obstruction. We describe a case of congenitally corrected transposition of the great arteries and previous surgical ventricular septal defect repair with recurrent left ventricular outflow tract obstruction. The patient underwent a hybrid procedure to stent the left ventricular outflow tract, which was successful with no re-intervention through 3 years of follow-up.

Modified Nikaidoh procedure in a patient with transposition of the great arteries, ventricular septal defect, and left ventricular outflow tract obstruction with unusual coronary anatomy

2011 ◽  
Vol 21 (6) ◽  
pp. 703-706 ◽  
Author(s):  
Murat Ugurlucan ◽  
Omer A. Sayin ◽  
Emin Tireli
Keyword(s):  
Coronary Artery ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow ◽  
The Right

AbstractThe Rastelli operation has been the most common procedure for the repair of transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction. A relatively recent approach is the Nikaidoh procedure. Despite the fact that it seems promising, the operation lacks long-term follow-up data. It has been postulated that patients with anomalous coronary arteries are high-risk candidates for the Nikaidoh procedure and its modifications. In this report, we present the case of a patient with transposition of the great arteries with remote restrictive ventricular septal defect and left ventricular outflow tract obstruction with coronary anomaly – with the right coronary artery originating from the left anterior descending coronary artery and crossing the right ventricular outflow tract – who underwent successful modified Nikaidoh operation.

scholarly journals Predictors of Left Ventricular Outflow Tract Obstruction After Primary Interrupted Aortic Arch Repair

2021 ◽  
Author(s):  
Nina A. Korsuize ◽  
Abraham van Wijk ◽  
Felix Haas ◽  
Heynric B. Grotenhuis
Keyword(s):  
Aortic Arch ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Interrupted Aortic Arch ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow ◽  
Aortic Arch Repair

AbstractLeft ventricular outflow tract obstruction is an important complication after interrupted aortic arch repair and subsequent interventions may adversely affect survival. Identification of patients at risk for obstruction is important to facilitate clinical decision-making and monitoring during follow-up. The aim of this review is to summarize reported risk factors for left ventricular outflow tract obstruction after corrective surgery for interrupted aortic arch. A systematic search of the literature was performed across the PubMed and EMBASE databases. Studies that reported echocardiographic and/or clinical predictors for left ventricular outflow tract obstruction in infants that underwent biventricular repair of interrupted aortic arch were included. From the 44 potentially relevant studies, eight studies met the inclusion criteria. Postoperative left ventricular outflow tract obstruction requiring an intervention was common, with an incidence ranging between 14 and 38%. Manifestation of postoperative left ventricular outflow tract obstruction was associated with a smaller pre-operative size of the aortic root (sinus of Valsalva), sinotubular junction, and aortic annulus. Anatomic and surgical risk factors for left ventricular outflow tract obstruction were the presence of an aberrant right subclavian artery, use of a pulmonary homograft or polytetrafluoroethylene interposition graft for aortic arch repair, and the presence of a small- or medium-sized ventricular septal defect. In patients with a borderline left ventricular outflow tract that undergo a primary repair, these (pre-) operative predictors can provide guidance for optimal surgical decision-making and for close monitoring during follow-up of patients at increased risk for developing left ventricular outflow tract obstruction after corrective surgery.

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