En-bloc Double Root Translocation In Transposition Of The Great Arteries With Pulmonary Valve Stenosis
Karthik Thangappan, MD, Awais Ashfaq, MD, Alan ODonnell, PA-C, Ryan Moore, MD, Nicholas Szugye, MD, David L. S. Morales, MD, James S. Tweddell, MD.
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Our patient is a 6 month old boy with a history of transposition of the great arteries (TGA), ventricular septal defect (VSD), dysplastic pulmonary valve (PV), left ventricular outflow tract (LVOT) obstruction, and PV stenosis. Patient underwent atrial septostomy (day of life 12) c/b progressive desaturation s/p pulmonary balloon valvuloplasty (2 months old). Patient then presented to our institution. Echocardiogram (Echo) demonstrated D-TGA with large conoventricular VSD, severe PV stenosis (bicuspid), moderate posterior-deviated conal septum LVOT obstruction, and normal ventricular function. Patient was taken to the operating room for double root translocation. The ascending aorta and main pulmonary artery were transected. Due to the hypoplastic and thickened appearance of the PV, we proceeded with en-bloc translocation. The coronary buttons were excised, followed by the aortic and pulmonary roots. The en-bloc root was rotated 180-degrees and re-implanted. The VSD was closed with a bovine pericardial patch. Pulmonary root reconstruction required a transannular patch of pulmonary homograft. The coronary buttons were re-implanted into the aortic root, followed by LeCompte maneuver to anastomose the root to the ascending aorta. The pulmonary artery was then anastomosed to the pulmonary root. Finally, the ASD was closed primarily. Intraoperative Echo showed good biventricular function, no LVOT obstruction, no residual VSD, but significant residual right ventricular outflow tract (RVOT) obstruction. The transannular patch was then enlarged with the addition of a bovine pericardial patch. Repeat Echo demonstrated no RVOT obstruction. Patient recovered well after surgery and was discharged home on postoperative day 7 in stable condition.
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