Right Transatrial Approach to Relieve Pulmonary Stenosis in Patients with Corrected Transposition of the Great Vessels: A New Operation Without Use of an Extracardiac Conduit

Abstract

Background: A new operation to relieve pulmonary obstruction is proposed for patients with corrected transposition of the great vessels and pulmonary stenosis (PS). A right transatrial approach involves excising or detaching the right‐sided atrioventricular valve (AV). Next, the pulmonary outflow tract is opened wide with an incision extending from the right‐sided ventricle upward across the AV valve annulus. This incision extends into the main trunk of the pulmonary artery located behind the right atrium. A patch, with or without implantation of a pulmonary valve prosthesis, widens the outflow tract, thus avoiding use of an extracardiac conduit. Method: We describe this operation performed in a 51‐year‐old man who had previously undergone correction with an extracardiac conduit that had become obstructed. The patient had severe right‐sided AV valve insufficiency and complete heart block with a functioning transvenous pacemaker. We replaced the right‐sided AV valve and positioned the permanent pacemaker lead outside of the prosthetic skirt. The PS was corrected as described above and a pulmonary prosthetic valve implanted. Use of an extracardiac conduit was avoided altogether. Conclusion: This technique may be applicable even without excising the right‐sided AV valve. The clinical result for our patient is still optimal 4 years after surgery.