Young-Sang Sohn, MD, Christian P

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Presentation transcript:

Arterial switch in hearts with left ventricular outflow and pulmonary valve abnormalities Young-Sang Sohn, MD, Christian P.R Brizard, MD, Andrew D Cochrane, James L Wilkinson, Carlos Mas, MD, Tom R Karl, MD The Annals of Thoracic Surgery Volume 66, Issue 3, Pages 842-848 (September 1998) DOI: 10.1016/S0003-4975(98)00693-6

Fig 1 Surgical options for patients with transposition of the great arteries (TGA) and left ventricular outflow tract abnormalities in the absence or presence of a ventricular septal defect. (ASO = arterial switch operation; LV-PA = left ventricle to pulmonary artery; LVOTO = left ventricular outflow tract obstruction; REV = réparation à l’étage ventriculaire.) The Annals of Thoracic Surgery 1998 66, 842-848DOI: (10.1016/S0003-4975(98)00693-6)

Fig 2 Distribution of left ventricular to arterial gradients preoperatively and postoperatively (at most recent follow-up over a total of 1,934 patient-months; mean follow-up, 81 months) in children undergoing arterial switch operation for transposition of the great arteries with left ventricular outflow tract abnormalities. Preoperative median was 30 mm Hg (range, 7 to 93 mm Hg). Two patients have had progression of the gradient after operation. Median at most recent follow-up was 0 mm Hg (range, 0 to 35 mm Hg). (LV = left ventricle; NeoAo = neoaortic; PA = pulmonary artery.) The Annals of Thoracic Surgery 1998 66, 842-848DOI: (10.1016/S0003-4975(98)00693-6)

Fig 3 Severe neoaortic dilatation in a child who had an arterial switch operation and resection of accessory tricuspid valve tissue 9 years earlier. This child had severe aortic insufficiency and a subvalvar fibrous membrane. He required aortic valve replacement, aortoplasty, and membrane resection. He had a normal appearing pulmonary valve and subvalvar area at the time of the original operation. The Annals of Thoracic Surgery 1998 66, 842-848DOI: (10.1016/S0003-4975(98)00693-6)

Fig 4 This isolated subvalvar fibrous membrane generated a 70-mm Hg left ventricle (LV) to pulmonary artery (PA) gradient, which was completely relieved by resection, plus arterial switch operation. (RV = right ventricle.) The Annals of Thoracic Surgery 1998 66, 842-848DOI: (10.1016/S0003-4975(98)00693-6)

Fig 5 Two-dimensional echocardiogram showing accessory tricuspid valve (TV) tissue prolapsed through a ventricular septal defect (VSD), causing significant left ventricular outflow tract obstruction in an infant with transposition of the great arteries (gradient = 50 mm). The obstruction was completely relieved after arterial switch operation and resection. (LV = left ventricle; PV = pulmonary valve; RV = right ventricle.) The Annals of Thoracic Surgery 1998 66, 842-848DOI: (10.1016/S0003-4975(98)00693-6)

Fig 6 Specimen from our anatomic collection showing accessory tricuspid valve tissue (arrow), which prolapsed through a ventricular septal defect, causing left ventricular outflow tract obstruction during life. The Annals of Thoracic Surgery 1998 66, 842-848DOI: (10.1016/S0003-4975(98)00693-6)

Fig 7 Anatomic specimen from our laboratory showing anomalous insertion of mitral tensor apparatus on the infundibular septum (arrow). This type of severe left ventricular outflow tract obstruction is difficult to relieve surgically, and options other than arterial switch operation should be considered. The Annals of Thoracic Surgery 1998 66, 842-848DOI: (10.1016/S0003-4975(98)00693-6)