Comparison of types of pulmonary stenosis with the state of the ventricular septum in complete transposition of the great arteries

Abstract

The pulmonary valve and left ventricular outflow tract of 214 hearts with d-transposition of the great arteries (d-TGA) were visually inspected (126 of 214 with intact ventricular septum and 88 of 214 with ventricular septal defect [VSD]). Pulmonary stenosis (PS), either valvular, subvalvular, or in combination, was present in 26 cases and was found to be more common in the presence of a VSD (20.5%) than intact ventricular septum (6.3%). PS occurred more commonly in the presence of a supracristal VSD than an infracristal VSD (70%, 7 of 10 vs 15%, 10 of 66). Further, infracristal or supracristal VSDs were associated with different types of pulmonary obstruction. In seven of ten cases with infracristal VSD and PS, the stenosis was caused by an anomaly of an atrioventricular valve. In six of seven cases with supracristal VSD and PS, the latter was caused by membranous encirclement of the left ventricular outflow tract.

Deep Phenotypic Analysis for Transposition of the Great Arteries and Prognosis Implication

“…The commonly accompanied phenotypes for TGA, VSD, and LVOTO are the most clinically challenging factors. 24 Surgical management for patients with anomalies of ventriculoarterial connection associated with VSD as well as pulmonary outflow tract obstruction continues to be a challenge because the anatomic correction of these lesions requires a complete reconstruction of the biventricular outflow tract. 25 VSD was reported as the risk factor for in‐hospital mortality, and patients who had TGA with VSD, or TGA with VSD plus LVOTO had a 3‐fold greater risk for late mortality than patients who had TGA with intact ventricular septal.…”

Extending the surgical boundaries in the management of the left ventricular outflow tract obstruction in discordant ventriculo-arterial connections – a surgical and morphological study

“…In the latter setting, usually known simply as ''transposition'', obstructive lesions have been described in from one-eighth to onethird of cases, [6][7][8][9] being more common in the presence of a ventricular septal defect than when the ventricular septum is intact. 8 When stenosis is produced by a malformed pulmonary valve, the valve is usually bifoliate and dysplastic, albeit that stenosis at valvar level is often accompanied by other forms of subpulmonary stenosis (Fig. 2).…”

“…1). In the latter setting, usually known simply as “transposition”, obstructive lesions have been described in from one-eighth to onethird of cases, 6 – 9 being more common in the presence of a ventricular septal defect than when the ventricular septum is intact 8 …”