Transposition of the great arteries with ventricular septal defect and left ventricle outflow tract obstruction: Pulmonary valve translocation

Abstract

The surgical technique choice for the treatment of transposition of the great arteries (TGA) with ventricular septal defect (VSD) and left ventricle outflow tract obstruction (LVOTO) has varied at different heart centers. Since April 1994, we have used the pulmonary root translocation (PRT) to approach this malformation as part of its anatomical repair. Afterwards, we extended its application to other types of congenital heart disease involving malposition of the great arteries, VSD and pulmonary ventricle outflow tract obstruction. We describe the detailed steps of this operation which consists of: removal of the pulmonary artery (PA) with the pulmonary valve from the left ventricle, resection of some conal septum, closure of the pulmonary root hole with autologous pericardial patch, construction of an intraventricular tunnel that diverted blood flow from the left ventricle to the aorta and connection of the pulmonary artery root to the right ventricle. Up to December 2013, 62 patients were subjected to PRT, being the TGA, VSD and PS the most frequent diagnosis (42 patients). Overall, there were 3 (4.8 %) early deaths and 2 (4.4 %) late death. Echocardiographic and follow-up studies on the initial series of 44 consecutive patients showed nonlinear growth of the pulmonary root and good performance of the valve at 10 years. Only 4 patients required reinterventions owing to right ventricular outflow tract problems. In conclusion: PRT is a good surgical alternative for treatment of patients with TGA complexes, VSD, and LVOTO, with acceptable operative risk, high long-term patient survival, and few reinterventions. Most patients had adequate pulmonary root growth and performance.