Nikaidoh Procedure For Transposition With Left Ventricular Outflow Tract Obstruction: Focusing On The Aortic Root Reinforcement And Coronary Artery Mobilization
Juan Contreras, MD1, Rachel Vanderlann, MD2, Osami Honjo, MD, PhD2.
1Universidad de La Frontera, Temuco, Chile, 2Hospital for Sick Children, Toronto, ON, Canada.
Nikaidoh procedure for complex transposition of the great arteries (TGA) and left ventricular outflow tract obstruction (LVOT) involves translocation of the aortic root posteriorly, posing the risk of aortic root distortion and coronary artery kinking. Herein a case of Nikaidoh procedure focusing on the techniques of preserving the translocated aortic root geometry and mobilization of coronary arteries is presented. The video presents a five-month-old infant with TGA/ventricular septal defect (VSD)/LVOT with severely hypoplastic pulmonary valve. After median sternotomy, the proximal coronary arteries (1LCx-2R) were completely mobilized until they reached the atrioventricular groove. Under cardiopulmonary bypass, both aorta and main pulmonary artery were transected and unsuitability of arterial switch operation was confirmed.The aortic root was harvested with both coronary arteries attached, and additional extensive coronary artery mobilization was performed. The pulmonary valve was transected across the infundibular septum connecting the incision to the VSD. After closing the VSD, the aortic root was reimplanted to the LVOT. We made sure the muscle structure of the aortic root was completely inserted within the LVOT, inside of the VSD patch to avoid future dilatation. A 14 mm Contegra conduit was placed in the right ventricular outflow tract. Echocardiogram showed no LVOT obstruction, no aortic inefficiency, and unobstructed coronary arteries. The patient was discharged home 5 days later. We conclude that placement of the aortic root inside of LVOT preserving aortic root geometry and aggressive mobilization of the coronary arteries to prevent kinking are essential operative steps to achieve successful procedural outcome.
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