Neopulmonary Stenosis After Arterial Switch

Abstract

The most common long-term complication following arterial switch is supravalvar neopulmonary stenosis. Balloon dilatation has not been effective in treating this problem since the stenosis is often found at multiple levels which will require complex surgical interventions. These include patch augmentation of the supravalvar apparatus, patch augmentation of the distal main and branch pulmonary arteries, and subvalvar muscular resection as needed. The surgical considerations to avoid and treat supravalvar neopulmonary stenosis are: (1) prevention at the time of arterial switch by the use of a pantaloon autologous pericardial patch and (2) application of appropriate surgical interventions at secondary operations for acquired right ventricular outflow tract obstruction. The purpose of this article is to illustrate the optimal methods to achieve these goals.