Double NeoRoot Translocation
Michael Ma, John Lamberti, Manan Desai.
Stanford University, Stanford, CA, USA.
Objective(s): To present a novel technique to address late neo-aortic insufficiency in Transposition of the Great Arteries that has the potential to salvage the deteriorating valve for use in the pulmonic circulation.
Methods: This is a single case video presentation.
Results: The patient is an 11yo 22.6kg female with D-TGA/VSD, bilateral SVCs, interrupted IVC, levocardia, who underwent multiple operations at an outside institution during her first year of life. She is now symptomatic, with severe eccentric neo-aortic insufficiency through a frozen leaflet and preserved neo-pulmonic valve function. The patient is offered an operation to improve her neo-aortic insufficiency, with several semilunar replacement options considered. Ultimately, she undergoes a double neo-root translocation, with repair of her neo-aortic root for use in the pulmonic circulation. This is complicated by heart block requiring pacemaker placement. Her ventricular and valvular function are appropriate at conclusion of her case, and at time of hospital discharge.
Conclusions: Double Neo-Root Translocation may be suitable in selected patients with neo-aortic insufficiency in Transposition of the Great Arteries. The neo-aortic root may not be adequate for systemic circulation, but repairable for use in the pulmonic circulation. The procedure does require careful assessment of surrounding anatomic structures, and great care must be taken to avoid injury to coronary arteries, the mitral valve apparatus, and the conduction system. More experience and longer follow-up are necessary.
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