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Late Results After Extended Pulmonary Artery Reconstruction in the Arterial Switch Operation  Michael V. Ullmann, MD, Matthias Gorenflo, MD, Christian.

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Presentation on theme: "Late Results After Extended Pulmonary Artery Reconstruction in the Arterial Switch Operation  Michael V. Ullmann, MD, Matthias Gorenflo, MD, Christian."— Presentation transcript:

1 Late Results After Extended Pulmonary Artery Reconstruction in the Arterial Switch Operation 
Michael V. Ullmann, MD, Matthias Gorenflo, MD, Christian Bolenz, Christian Sebening, MD, Michael Goetze, MD, Raoul Arnold, MD, Herbert E. Ulmer, MD, Siegfried Hagl, MD  The Annals of Thoracic Surgery  Volume 81, Issue 6, Pages (June 2006) DOI: /j.athoracsur Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 Schematic illustration of different transection levels (dashed circles) of the aorta and pulmonary artery in the arterial switch operation with extended pulmonary artery reconstruction. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 Schematic illustration of coronary ostia excision as buttons out of the aortic root in form of an “O” for the right coronary artery and in form of a “U” for the left coronary artery (dashed line, left side) followed by the anterior placement of the pulmonary artery (Lecompte maneuver [17]) after performing a large incision of the posterior wall of the pulmonary bifurcation and left pulmonary artery including the proximal part of the right pulmonary artery (thin dashed line, right side). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 Schematic illustration of defect closure of the neopulmonary root using two glutaraldehyde-treated autologous pericardial patches (grey), a small round one for the right-sided defect (left side) and a large triangular one for the left-sided defect (right side) after anterior placement of the pulmonary artery (Lecompte maneuver [17]). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 Schematic illustration of the neopulmonary root and pulmonary artery after extended pericardial patch reconstruction in the arterial switch operation with augmentation of the posterior wall of the neopulmonary root, the main pulmonary artery, the pulmonary bifurcation, the left pulmonary artery, and the proximal part of the right pulmonary artery (front view). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

6 Fig 5 Schematic illustration of the neopulmonary root and pulmonary artery after extended pericardial patch reconstruction in the arterial switch operation with augmentation of the posterior wall of the neopulmonary root, the main pulmonary artery, the pulmonary bifurcation, the left pulmonary artery, and the proximal part of the right pulmonary artery (back view). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

7 Fig 6 Preoperative angiogram showing the transposition of the great arteries with the main pulmonary artery originating from the left ventricle (front view, patient No. 39). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

8 Fig 7 Late postoperative angiogram of the neopulmonary root, the main pulmonary artery, the pulmonary bifurcation, and the left and right pulmonary artery after extended pulmonary artery reconstruction in the arterial switch operation (front view, patient No. 39). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

9 Fig 8 Late postoperative angiogram of the neopulmonary root, the main pulmonary artery, the pulmonary bifurcation, and the left and right pulmonary artery after extended pulmonary artery reconstruction in the arterial switch operation (lateral view, patient No. 39). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

10 Fig 9 Comparison of maximal transpulmonary continuous-wave (cw)-Doppler gradient at discharge and at the latest follow-up (FU) echocardiographic examination in patients with a follow-up of 5 years or more after the arterial switch operation with extended reconstruction of the neopulmonary root, pulmonary trunk, and left pulmonary artery (n = 58). The box represents the median and the 25th and 75th percentiles. The error bars (−) represent the 10th and the 90th percentiles. The circles represent the outliers (ns = not significant). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

11 Fig 10 Distribution of maximal transpulmonary continuous-wave (cw)-Doppler gradient (mm Hg) at the latest follow-up (FU) echocardiographic examination in patients with a follow-up of 5 years or more after the arterial switch operation with extended reconstruction of the neopulmonary root, pulmonary trunk, and left pulmonary artery (n = 58). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions


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