Aortic Root Translocation Plus Arterial Switch for Transposition of the Great Arteries With Left Ventricular Outflow Tract Obstruction
Intermediate-Term Results
Victor Bautista-Hernandez, MD,
Gerald R. Marx, MD,
Emile A. Bacha, MD and
Pedro J. del Nido, MD*
Department of Cardiac Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
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Figure 1 Aortic Autograft Excision
The ventricular and aortic incisions required for aortic autograft excision are shown. Note that the infundibular incision is circumferential just below the aortic annulus. The coronary ostia are excised as circular buttons from the respective sinuses of Valsalva.
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Figure 2 Ross-Switch-Konno Procedure
Once the aortic autograft is excised and the coronaries are mobilized, the main pulmonary artery is transected and an incision is extended across the pulmonary valve annulus and outlet septum connecting to the ventricular septal defect (VSD), if present. Enlargement of the left ventricular outflow tract is then accomplished by insertion of a triangular-shaped VSD patch.
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Figure 3 Lecompte Maneuver
The aortic autograft is re-inserted into the left ventricular outflow. The aortic root autograft is then rotated 180° so that the defects from the coronary buttons face anteriorly. The coronaries are then reimplanted. Before re-establishing ascending aortic continuity, the branch pulmonary arteries are mobilized and brought anterior to the aorta (Lecompte maneuver) in preparation for right ventricular outflow reconstruction.
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Figure 4 Insertion of Interposition Homograft
The RV-to-PA continuity is achieved by insertion of an interposition homograft connecting the RV infundibulum to the pulmonary trunk. PA = pulmonary artery; RV = right ventricle/ventricular.
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