Modified arterial switch operation by spiral reconstruction of the great arteries in transposition

Chiu, Ing‐Sh; Wu, Shye-Jao; Chen, Ming–Ren; Lee, Meng-Luen; Wu, Mei‐Hwan; Wang, Jou‐Kou; Lue, Hung-Chi

doi:10.1016/s0003-4975(00)01423-5

Cited by 26 publications

(27 citation statements)

References 22 publications

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“…In our experience, restoration of a natural and smooth flow to both RPA and LPA in spiral fashion [25] is more helpful than Lecompte maneuver with a sole huge patch [5, 6, 12]. The other alternative is to anastomose the distal PT directly to the aortic sinus defect without a patch [26].…”

Section: Discussionmentioning

confidence: 99%

Morphologic Substrates for First-Branch Pulmonary Arterial Hypoplasia in Transposition of the Great Arteries

Chen

Wu²,

Chiu³

et al. 2007

Cardiology

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Background: Distal right-sided outflow obstruction remains a problem after arterial switch operation. We studied the anatomical features of the pulmonary trunk (PT) and its branches that are susceptible to right and left pulmonary arterial (RPA and LPA) hypoplasia in transposition of the great arteries (TGA). Methods: One hundred and one angiograms of TGA performed between 1981 and 1996 were viewed, and Polaroid photos were taken at end-systole. The diameters of RPA, LPA, PT, duct, ascending aorta, and angles between PA and PT were measured, and the ductal flow direction was recorded. Results: Forty-eight cases (47.5%) had a PA/PT diameter ratio (both PAs had same size) below 0.49. A smaller PA/PT was significantly related to posterior inclination of the proximal PT [narrower right (r = 0.50, p < 0.00001) and left (r = 0.48, p < 0.00001) PA-PT angle in lateral view] and a larger duct (r = 0.37, p < 0.0001). Eighteen patients had a follow-up angiogram after a mean period of 8.5 months. Those with a closed duct had evident PA growth (n = 12, 0.51 ± 0.09 to 0.74 ± 0.17, p < 0.0001), but four patients with an attenuated duct had no significant change (0.58 ± 0.06 to 0.68 ± 0.08, p = NS), and one with a persistent large duct had even regression of PA/PT (0.36–0.19). The direction of ductal flow was toward the aorta during early systole on cineangiogram. Conclusions: First-branch PA hypoplasia, which is frequently seen in TGA, was related to the right-to-left shunt through a duct resulting in hemodynamic starvation, and to posterior inclination of the proximal PT in this setting. Natural regression of the duct facilitated PA growth.

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Section: Discussionmentioning

confidence: 99%

Morphologic Substrates for First-Branch Pulmonary Arterial Hypoplasia in Transposition of the Great Arteries

Chen

Wu²,

Chiu³

et al. 2007

Cardiology

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“…The purpose of this aortic lip ( Fig. 2) is used to cover the left-sided portion of the neo-aortic stump [6,7], in order to solve the problem of size discrepancy when connecting a small aorta to a huge old MPA stump, the other effect is to act as the floor of the neopulmonic pathway. Here we utilised an aortic pedical graft to achieve these two effects.…”

Section: Resultsmentioning

confidence: 99%

“…Spiral ASO was performed in 48 (36.9%), whereas conventional nonspiral ASO with Lecompte manoeuvre in 82 patients (63.1%). The technical details of spiral ASO are reported elsewhere [6,7]. In brief, the central pulmonary artery (PA) after main PA (MPA) bifurcation was retained behind the aorta, and MPA was routed alongside the neo-aorta anterolaterally to the central PA, using part of the aorta wall and a proper-sized pericardium (Videos 1 and 2 with narration).…”

Section: Methodsmentioning

confidence: 99%

Restoring the spiral flow of nature in transposed great arteries

Chiu

Huang

Chen

et al. 2010

European Journal of Cardio-Thoracic Surgery

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Intermediate-term results of spiral ASO were satisfactory. Transposition is not a mere reversal of the great arteries; therefore, recognition of non-spiral relationship should be appreciated. Spiral reconstruction would be beneficial to reduce supravalvular PS and neo-aortic kinking. Further recognition of spiral function and refined modification might justify the application of spiral ASO in the future.

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“…The coronary arteries were translocated first and the neo-aorta was anastomosed. After finishing reconstruction of the neo-aorta, two kinds of neo-PA were reconstructed either with Lecompte maneuver and large pericardial augmentation or with a spiral reconstruction technique which was described in detail elsewhere [20, 21]. The spiral reconstruction was conducted with partial incision at the coronary button and anastomosis with semiflap of the pulmonary arterial root.…”

Section: Methodsmentioning

confidence: 99%

Prediction of Early Pulmonary Artery Stenosis after Arterial Switch Operation: The Role of Intraoperative Transesophageal Echocardiography

Chen¹,

Tsai

Chang³

et al. 2007

Cardiology

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Objectives: To investigate prospectively the prediction of the neopulmonary stenosis (neo-PS) after arterial switch operation (ASO) for transposition of the great artery (TGA) with intraoperative transesophageal echocardiography (TEE). Methods: Infants with TGA undergoing the ASO were prospectively studied over 5 years. The neo-PS was defined when the peak flow velocity was over 3 m/s at the neo main pulmonary artery (neo-MPA) after ASO by TEE (TEEPS). Catheterization was performed if estimated peak neo-PS pressure gradient was over 40 mm Hg by transthoracic echocardiography. Balloon angioplasty was tried first and surgical reoperation was reserved for those with failed angioplasty. Results: In total 49 consecutive patients were enrolled into the cohort study. TEEPS was identified in 21 patients. For patients with TEEPS, freedom from reintervention was 28% at 1 year and 23% at 2 years. For patients without TEEPS, freedom from reintervention for PS was 92% at 1 year and 78% at 2 years. The time interval from ASO to reintervention was significantly shorter in patients with TEEPS than without TEEPS. Existence of TEEPS and non-Lecompte method were main risk factor for reintervention. Conclusion: The present study demonstrated that the application of intraoperative TEE for infants undergoing ASO is very helpful in predicting the development of early postoperative neo-PS.

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Modified arterial switch operation by spiral reconstruction of the great arteries in transposition

Cited by 26 publications

References 22 publications

Morphologic Substrates for First-Branch Pulmonary Arterial Hypoplasia in Transposition of the Great Arteries

Morphologic Substrates for First-Branch Pulmonary Arterial Hypoplasia in Transposition of the Great Arteries

Restoring the spiral flow of nature in transposed great arteries

Prediction of Early Pulmonary Artery Stenosis after Arterial Switch Operation: The Role of Intraoperative Transesophageal Echocardiography

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