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Eur J Cardiothorac Surg 2007;31:1150-1151. doi:10.1016/j.ejcts.2007.02.024
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Letters to the Editor

Aortic translocation for transposition of great arteries and left ventricular outflow tract obstruction

Istanbul University Istanbul Medical Faculty, Department of Cardiovascular Surgery, Istanbul, Turkey

Received 18 January 2007; accepted 28 February 2007.

^_* Corresponding author. Address: Istanbul University Istanbul Medical Faculty, Department of Cardiovascular Surgery, Millet Caddesi, 34390 Capa/Fatih, Istanbul, Turkey. Tel.: +90 212 414 20 00x326 60; fax: +90 212 534 22 32. (Email: emintireli{at}yahoo.com).

Key Words: Transposition of great arteries • Left ventricular outflow tract obstruction • Aortic translocation

We read with interest the manuscript entitled ‘Aortic translocation for the management of transposition of the great arteries with a ventricular septal defect, pulmonary stenosis, and hypoplasia of the right ventricle’ by Morell and Wearden [1]. However, we believe that there are some major points that should be discussed in detail.

Morell and Wearden, in their paper, advocate the advantage of aortic translocation for the preservation of the right ventricular volume when compared with the Rastelli procedure and its modifications. It is understood from their case that the pulmonary annulus was measured to be 0.69 cm. In such a case, we believe that resection at the subpulmonic region and resection of the superior segment of the VSD and then VSD closure and conventional arterial switch operation seems to be more efficacious than aortic translocation. In standard arterial switch operation, since the pulmonary valves are preserved, this helps to aid the already hypoplastic right ventricle and its functions; although in the long term, regurgitation of the neoaortic valve may ensue. In aortic translocation, since the pulmonary artery is directly anastomosed to the right ventricle, this adversely affects the moderately hypoplastic right ventricular functions. This may be the major cause of postopertive third day ECMO requirement after 12 h of extubation in Morell and Wearden's case.

According to our experiences, in the neonatal period, for the patients with VSD, moderately LVOT obstruction and bicuspid pulmonary valves, resection and arterial switch operation when the Z value of pulmonary annulus is above –3, does not lead to a significant left ventricle to aorta gradient, thus in such cases we do not prefer aortic translocation. And we believe that this is beneficial, especially in the neonatal period. According to the echocardiographic images of the authors’ case, by resection of the superior segment of the VSD, that is enlargement of the subpulmonic region by resection of the superior rim of VSD, we propose that standard arterial switch following VSD closure could easily be performed.

We performed modified Nikaidoh procedure in only one case in which the pulmonary annulus Z score was below –3 with severe LVOT obstruction. And in this patient, the modification was long segment preparation of RCA and removal of LDA from the aorta as a button and after the aortic translocation; LAD was reimplanted to the aorta [2].

We believe that, in Morell and Wearden's case, LVOT resection and standard arterial switch would be more beneficial for the preservation of the right ventricle functions.

References

1. Morell VO, Wearden PD. Aortic translocation for the management of transposition of the great arteries with a ventricular septal defect, pulmonary stenosis, and hypoplasia of the right ventricle. Eur J Cardiothorac Surg 2007;31:552-554.[Abstract/Free Full Text]
2. Sayin OA, Ugurlucan M, Saltik L, Sungur Z, Tireli E. Modified Nikaidoh procedure for transposition of great arteries, ventricular septal defect and left ventricular outflow tract obstruction. Thorac Cardiovasc Surg 2006;54(8):558-560.[CrossRef][Medline]

This article has been cited by other articles:

				V. O. Morell Reply to Ugurlucan and Tireli Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 1151 - 1151. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Emin Tireli Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ugurlucan, M. Articles by Tireli, E. Search for Related Content PubMed PubMed Citation Articles by Ugurlucan, M. Articles by Tireli, E. Related Collections Congenital - cyanotic Great vessels