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Intermediate-term results of the Senning or Mustard procedures combined with the Rastelli operation for patients with discordant atrioventricular connections associated with discordant ventriculoarterial connections or double outlet right ventricle

Published online by Cambridge University Press:  23 January 2007

Jürgen Hörer ,
Felix Haas ,
Julie Cleuziou ,
Christian Schreiber ,
Martin Kostolny ,
Manfred Vogt ,
Klaus Holper  and
Rüdiger Lange
Jürgen Hörer
Affiliation:
Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University, Germany
Felix Haas
Affiliation:
Department of Pediatric Cardiothoracic Surgery, Wilhelmina Children's Hospital, UMC Utrecht, The Netherlands
Julie Cleuziou
Affiliation:
Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University, Germany
Christian Schreiber
Affiliation:
Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University, Germany
Martin Kostolny
Affiliation:
Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University, Germany
Manfred Vogt
Affiliation:
Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich at the Technical University, Germany
Klaus Holper
Affiliation:
Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University, Germany
Rüdiger Lange
Affiliation:
Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University, Germany
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Abstract

Background: In patients with discordant atrioventricular and ventriculoarterial connections, anatomic repair restores the morphologically left ventricle to its role in supporting the systemic circulation. In this study, we have evaluated the outcomes in the intermediate term for this complex surgical procedure. Methods: Between December 1984 and October 2003, 4 patients underwent an atrial switch operation concomitantly with a Rastelli operation, and 2 patients underwent an atrial switch operation and a patch-plasty of the pulmonary outflow tract for anatomic repair at a mean age of 3.3 plus or minus 2.1 years. All patients had intracardiac rerouting, connecting the morphologically left ventricle to the aorta. Results: There were no hospital deaths. In 5 patients, reoperation was needed, either for baffle complications, exchange of the conduit, repair of a residual ventricular septal defect, or relief of obstruction within the left ventricular outflow tract. Death occurred in 1 patient, from cardiac failure 6 months after correction. Mean follow-up time was 6.5 plus or minus 6.4 years, with a range from 6 months to 17 years. At follow-up, 1 patient presented with moderate tricuspid insufficiency, and 1 patient with mild obstruction of the pulmonary venous pathway. The remaining 3 patients showed good left and right ventricular function, and no, or mild tricuspid and mitral insufficiency. Conclusions: Anatomic repair can be performed with low hospital mortality. Restoration of the morphologically left ventricle into the systemic circulation in patients with discordant atrioventricular and ventriculoarterial connections is a demanding approach, associated with various reoperations over time. Despite this, the approach seems to be an appropriate solution for selected patients, since the majority of the patients show good left and right ventricular function, and no, or mild tricuspid and mitral insufficiency up to 17 years after correction.

Keywords

Heart defect, congenitalsurgerytransposition of great vesselsatrial switch operationRastelli operation
Type
Original Article
Information
Cardiology in the Young , Volume 17 , Issue 2 , April 2007 , pp. 158 - 165
Copyright
© 2007 Cambridge University Press

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