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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 1999 April;40(2):313-6

language: English

Arterial ­switch ­with inter­nal pul­mo­nary ­artery band­ing. A new pal­li­a­tion for TGA and VSD in com­plex cas­es

Conte S., Jensen T. *, Ramsoe Jacobsen J. *, Lauridsen P., Pettersson G.

From the Departments of Cardiothoracic Surgery and * Pediatrics The National University Hospital “Rigshospitalet” Copenhagen, Denmark


In ­most cas­es, one ­stage ­repair by arte­ri­al ­switch oper­a­tion (ASO) is the opti­mal treat­ment for neo­nates ­with trans­po­si­tion of the ­great arter­ies (TGA). Nevertheless, a ven­tric­u­lar sep­tal ­defect (VSD) asso­ciat­ed ­with TGA ­remains a ­major ­risk fac­tor for ear­ly ­death and reop­er­a­tion ­after com­plete ­repair in neo­nates ­with com­plex anat­o­my. A new pal­li­a­tive ­ap-proach for ­such spe­cif­ic cas­es is pro­posed. An inter­nal pul­mo­nary ­artery band­ing (­IPAB), as ­that ­already ­used to pal­li­ate oth­er car­diac mal­for­ma­tions, is per­formed in asso­ci­a­tion ­with ASO ­instead of VSD clo­sure. At the end of ASO, a cir­cu­lar poly­tet­ra­flu­o­reth­y­lene (­PTFE) ­patch ­with a 4-mm cen­tral ­hole is over­sewn ­into the neo-pul­mo­nary ­trunk. We adopt­ed ­this meth­od in a 17-day-old boy ­with TGA, VSD, hypo­plas­tic tri­cus­pid ­valve and dimin­u­tive ­right ven­tri­cle. After the oper­a­tion the ­child ­thrived and was ­doing ­well with­out med­i­ca­tion. Satisfactory ­growth of the ­right ven­tri­cle and tri­cus­pid ­valve was ­observed by ech­o­car­di­og­ra­phy dur­ing the fol­low­ing ­months. The ­patient suc­cess­ful­ly under­went VSD clo­sure and ­IPAB remov­al 2 ­years ­after the ­first pro­ce­dure. ASO ­with ­IPAB ­could be appri­o­pri­ate in all ­forms of TGA and VSD in ­which VSD clo­sure ­appears too chal­leng­ing in the neo­na­tal peri­od and in ­patients ­with uncer­tain suit­abil­ity for biven­tric­u­lar ­repair. We pre­ferred to use ­IPAB ­instead of clas­sic PAB in ­order to ­reduce the ­risk of pul­mo­nary ­valve dam­age, pul­mo­nary ­artery dis­tor­tion, and ­above all pul­mo­nary ­artery dil­a­ta­tion and relat­ed cor­o­nary com­pres­sion. In the pre­sent­ed ­case the strat­e­gy as ­well as ­IPAB ­worked accord­ing to our expec­ta­tions.

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