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Supravalvar pulmonary stenosis following the arterial switch operation for complete transposition: aetiological and surgical considerations

Published online by Cambridge University Press:  19 August 2008

Luca Testolin ,
Giovanni Stellin ,
Roberto Bianco ,
Maurizio Rubino ,
Guido Michielon ,
Nicoletta Salviato ,
Ornella Milanesi ,
Giorgio Svaluto Moreolo  and
Dino Casarotto
Luca Testolin*
Affiliation:
Department of Cardiovascular Surgery, University of Padova Medical School, Padova, Italy
Giovanni Stellin
Affiliation:
Department of Cardiovascular Surgery, University of Padova Medical School, Padova, Italy
Roberto Bianco
Affiliation:
Department of Cardiovascular Surgery, University of Padova Medical School, Padova, Italy
Maurizio Rubino
Affiliation:
Department of Cardiovascular Surgery, University of Padova Medical School, Padova, Italy
Guido Michielon
Affiliation:
Department of Cardiovascular Surgery, University of Padova Medical School, Padova, Italy
Nicoletta Salviato
Affiliation:
Department of Cardiovascular Surgery, University of Padova Medical School, Padova, Italy
Ornella Milanesi
Affiliation:
Department of Cardiovascular Surgery, University of Padova Medical School, Padova, Italy Department of PaediatricsUniversity of Padova Medical School, Padova, Italy
Giorgio Svaluto Moreolo
Affiliation:
Department of Cardiovascular Surgery, University of Padova Medical School, Padova, Italy Department of PaediatricsUniversity of Padova Medical School, Padova, Italy
Dino Casarotto
Affiliation:
Department of Cardiovascular Surgery, University of Padova Medical School, Padova, Italy
*
Luca Testolin, Istituto di Chirurgia Cardiovascolare, Centro “Vincenzo Gallucci”, Policlinico Universitario, Via Giustiniani 2, 35128 Padova, Italy. Tel: (39-49) 8212410-11-12, Fax: (39-49) 8212409.
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Abstract

From January 1988 through to July 1994, 54 consecutive infants underwent an arterial switch operation for simple or more complex forms of complete transposition (concordant atrioventricular and discordant ventriculo-arterial connections). They ranged in age from 2 to 180 days. The Lecompte maneuver was performed in all. In the first 19 patients the harvested sinuses of Valsalva were filled with two separate patches of autologous preserved pericardium, while, in the last 35 patients, a wide pantaloon patch of tanned pericardium was employed. Five babies died within 30 days after the procedure (operative mortality of 9.2%, 70% CL 4–17%). Four survivors were found to have developed a significant supravalvar pulmonary stenosis from 1 month to 21 months postoperatively. Echocardiographic data showed a transpulmonary peak systolic gradient from 60 mmHg to 101 mmHg, with a right-to-left ventricular systolic pressure ratio from 0.65 to 0.9. Reoperation was performed from 8 months to 39 months after the arterial switch procedure. Supravalvar pulmonary stenosis was located at the level of the pulmonary trunk, extending distally in two cases, due to the growth of fibrous scarring tissue with partial calcification. The pulmonary valvar leaflets were involved in two cases. Relief of the obstruction was obtained by insertion of a wide shield-tailored polytetrafluoroethylene patch after making an inverted Y-shaped longitudinal incision in the pulmonary trunk between the anterior sinuses of Valsalva. No mortality occurred at reoperation. Early and midterm echocardiographic measurements showed the effectiveness of this technique, with only trivial or mild residual transpulmonary gradients.

Keywords

Arterial switch operationtransposition of the great arteriessupravalvar pulmonary stenosis
Type
Original Articles
Information
Cardiology in the Young , Volume 7 , Issue 1 , January 1997 , pp. 31 - 36
Copyright
Copyright © Cambridge University Press 1997

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References

1.Castañeda, AR, Trusler, GA, Paul, MH, Blackstone, EH, Kirklin, JW.The early results of treatment of simple transposition in the current era. J Thorac Cardiovasc Surg 1988; 95: 14–28.CrossRefGoogle ScholarPubMed
2.Norwood, WI, Dobell, AR, Freed, MD, Kirklin, JW, Blackstone, EH.Intermediate results of the arterial switch repair: a 20 institution study. J Thorac Cardiovasc Surg 1988; 96: 854–863.CrossRefGoogle ScholarPubMed
3.Castañeda, AR, Norwood, WI, Lang, P, Sanders, SP.Transposition of the great arteries and intact ventricular septum: anatomical repair in the neonate. Ann Thorac Surg 1984; 38: 438.CrossRefGoogle ScholarPubMed
4.Yacoub, MH, Bernhard, A, Radley-Smith, R, Lange, P, Sievers, H, Heintzen, P.Supravalvular pulmonary stenosis after anatomic correction of transposition of the great arteries: causes and prevention. Circulation 1982; 66(Suppl I): I193–I197.Google ScholarPubMed
5.Bical, O, Hazan, E, Lecompte, YFermont, LKaram, JJarreau, MM, Tran, Viet TSidi, DLeca, FNeveux, JY. Anatomic correction of transposition of the great arteries associated with ventricular septal defect: midterm results in 50 patients. Circulation 1984; 5: 891–897.CrossRefGoogle Scholar
6.Kanter, KR, Anderson, RH, Lincoln, CRigby, ML, Shinebourne, EA.Anatomic correction for complete transposition and double-outlet right ventricle. J Thorac Cardiovasc Surg 1985; 90: 690–699.CrossRefGoogle ScholarPubMed
7.Planchè, CBruniaux, JLacour-Gayet, FKachaner, JBinet, JP, Sidi, DVillain, E.Switch operation for transposition of the great arteries in neonates. J Thorac Cardiovasc Surg 1988; 96: 354–363.CrossRefGoogle ScholarPubMed
8.Lecompte, YZannini, LHazan, EJarreau, MM, Bex, JP, Tran, Viet TNeveux, JY. Anatomic correction of transposition of the great arteries. New technique without use of a prosthetic conduit. J Thorac Cardiovasc Surg 1981; 82: 629–631.CrossRefGoogle ScholarPubMed
9.Doty, DB, Polansky, DB, Jenson, CB.Supravalvular aortic stenosis. Repair by extended aortoplasty. J Thorac Cardiovasc Surg 1977; 74: 362–371.CrossRefGoogle ScholarPubMed
10.Jatene, AD, Fontes, VS, Paulista, PP, Sousa, LCB, Neger, FGalantier, MSousa, JEMR. Successful anatomic correction of transposition of the great vessels. A preliminary report. Arq Bras Cardiol 1975; 28: 461–464.Google ScholarPubMed
11.Hougen, TJ, Colan, SD, Norwood, WI, Sanders, SP, Lang, PJonas, RA, Castaneda, AR. Hemodynamic results of arterial switch operation for transposition of the great arteries, intact ventricular septum. Circulation 1984; 70(Suppl II):II26.Google Scholar
12.Quaegebeur, JM, Rohmer, JOttenkamp, JBuis, TKirklin, JW, Blackstone, EH, Brom, AG.The arterial switch operation. A eight-year experience. J Thorac Cardiovasc Surg 1986; 92: 361–384.CrossRefGoogle ScholarPubMed
13.Paillole, CSidi, DKachaner, JPlanche, CBelot, JP, Villain, E Le Bidois, JPiechaud, JF, Pedroni, E.Fate of pulmonary artery after anatomic correction of simple transposition of great arteries in newborns infants. Circulation 1988; 78: 870–876.Google Scholar
14.Martin, RP, Ladusans, EJ, Parsons, JM, Keek, ERadley-Smith, RYacoub, MH.Incidence and site of pulmonary stenosis after anatomical correction of transposition of the great arteries. Br Heart J 1988; 59: 122–123.Google Scholar
15.Lupinetti, FM, Bove, EL, Minich, L La, Snider, RCallow, LB, Mellone, S Jn, Crowley, DC, Beekman, RH, Serwer, GDick, II M, Vermilion, RRosenthal, A.Intermediate-term survival and functional results after arterial repair for transposition of the great arteries. J Thorac Cardiovasc Surg 1992; 103: 421–427.CrossRefGoogle ScholarPubMed
16.Sidi, DPlanche, CKachaner, JBruniaux, JVillain, ELe Bidois, JPiechaud, JF, Lacour-Gayet, F.Anatomic correction of simple Transposition of the great arteries in 50 neonates. Circulation 1987; 75: 429–435.CrossRefGoogle ScholarPubMed
17.Wernovsky, GHougen, TJ, Walsh, EP, Sholler, GF, Colan, SD, Sanders, SP, Parness, IA, Keane, JF, Mayer, JE, Jonas, RA, Castaneda, AR, Lang, P.Midterm results after the arterial switch operation for transposition of the great arteries with intact ventricular septum: clinical, hemodynamic, echocardiographic, and electrophysiologic data. Circulation 1988; 77: 1333–1344.CrossRefGoogle ScholarPubMed
18.Saxena, AFong, LV, Ogilvie, BC, Keeton, BR.Use of balloon dilatation to treat supravalvular pulmonary stenosis developing after anatomical correction for complete transposition. Br Heart J 1990; 64: 151–155.CrossRefGoogle Scholar