In the Footsteps of Senning: Lessons Learned From Atrial Repair of Transposition of the Great Arteries Ali Dodge-Khatami, MD, PhD, Alexander Kadner,

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Presentation transcript:

In the Footsteps of Senning: Lessons Learned From Atrial Repair of Transposition of the Great Arteries Ali Dodge-Khatami, MD, PhD, Alexander Kadner, MD, Felix Berger, MD, Hitendu Dave, MD, Marko I. Turina, MD, René Prêtre, MD The Annals of Thoracic Surgery Volume 79, Issue 4, Pages 1433-1444 (April 2005) DOI: 10.1016/j.athoracsur.2004.04.013

Fig 1 Surgeon's view and the proposed trap door right atrial incision in dashed lines. The cannulas for cardiopulmonary bypass are not shown. (IVC = inferior vena cava; SVC = superior vena cava.) The Annals of Thoracic Surgery 2005 79, 1433-1444DOI: (10.1016/j.athoracsur.2004.04.013)

Fig 2 The right atrium has been opened, with the proposed incision in the interatrial septum (dashed line) for the future septal flap. Note the extension of this incision into the mouth of the coronary sinus. (AV = atrioventricular.) The Annals of Thoracic Surgery 2005 79, 1433-1444DOI: (10.1016/j.athoracsur.2004.04.013)

Fig 3 The septal flap is dropped down into the left atrium and sewn over the orifices of the pulmonary veins. Note the pericardial patch that is sutured to the septal flap, thus filling the defect left by the foramen ovale, and enlarging the pulmonary venous atrium. (SVC = superior vena cava.) The Annals of Thoracic Surgery 2005 79, 1433-1444DOI: (10.1016/j.athoracsur.2004.04.013)

Fig 4 The pulmonary veins have been covered by the septal flap. The white arrows show the redirected systemic venous blood flow, from the two caval veins towards the mitral valve. (IVC = inferior vena cava; SVC = superior vena cava.) The Annals of Thoracic Surgery 2005 79, 1433-1444DOI: (10.1016/j.athoracsur.2004.04.013)

Fig 5 The systemic venous tunnel has been completed. The pedicled pericardial flap is sutured to the opening in the left atrium, and its free edge will be sutured to the opening in the right atrium, thus completing the neo-pulmonary atrium. The white arrow shows the redirected flow of pulmonary venous blood from the left atrium towards the tricuspid valve, traveling over and around the systemic venous tunnel. The inset shows the completed repair, with the augmented pulmonary venous atrium, and branches of the pericardiophrenic artery. (IVC = inferior vena cava; SVC = superior vena cava.) The Annals of Thoracic Surgery 2005 79, 1433-1444DOI: (10.1016/j.athoracsur.2004.04.013)

Fig 6 Cardiac angiography with contrast injection of the systemic venous tunnel and the bend it performs around the septal flap. The Annals of Thoracic Surgery 2005 79, 1433-1444DOI: (10.1016/j.athoracsur.2004.04.013)