Eur J Cardiothorac Surg 2007;31:1151. doi:10.1016/j.ejcts.2007.02.026
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
Reply to Ugurlucan and Tireli
Victor O. Morell*
Section of Pediatric Cardiothoracic Surgery of the Heart, Lung and Esophageal Surgical Institute, University of Pittsburgh Medical School, Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
Received 27 February 2007;
accepted 28 February 2007.
* Corresponding author. Address: University of Pittsburgh, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Room 2820, Pittsburgh, PA 15213, United States. Tel.: +1 412 692 5218; fax: +1 412 692 5817. (Email: victor.morell{at}chp.edu).
Key Words: Aortic translocation • Transposition of the great arteries
I would like to thank Ugurlucan and Tireli for their comments on our report [1,2]. In principle I am in agreement with their belief that a standard arterial switch operation with left ventricular outflow tract resection is preferable to an aortic translocation procedure in the management of some patients with TGA with a VSD and PS. With this particular cardiac lesion it is very important to delineate the anatomy of the LVOT including the size of the pulmonary valve annulus, the morphology of the pulmonary valve, and size of the LVOT. Our patient had a hypoplastic pulmonary valve annulus with a very dysplastic pulmonary valve, which factored in the decision to proceed with aortic translocation. The cardiac arrest the patient suffered on postoperative day #3 was clearly related to a respiratory event that could have been better managed, I would have to disagree with their suggestion that it was secondary to decreased right ventricular function. At no time during the hospitalization were there any findings (clinical or echocardiographic) to suggest abnormal right ventricular function. We are convinced that the aortic translocation procedure is superior to the Rastelli repair in preserving right ventricular volume. Therefore, in the presence of TGA with VSD, PS and a hypoplastic RV, when unable to perform a standard arterial switch with LVOT resection and VSD closure, the aortic translocation technique should be the procedure of choice.
References
- Ugurlucan M, Tireli E. Aortic translocation for transposition of the great arteries and left ventricular outflow tract obstruction. Eur J Cardiothorac Surg 2007;31:1150.[Free Full Text]
- 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 Cardiothoracic Surgery 2007;31:552-554.[CrossRef]
