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Corrected Transposition of the Great Arteries

  • Viktor Hraška
  • Peter Murín

Abstract

Congenitally corrected transposition is a rare condition, characterized by atrio-ventricular and ventricular–arterial discordance. The clinical presentation and indication for surgery generally depends on the associated cardiac lesions such as ventricular septal defect, obstruction of the outflow tract from the morphologically left ventricle, abnormalities of the morphologically tricuspid valve, and problems with the conduction system.

Operations for congenitally corrected transposition fall into four categories:
  1. 1.

    Temporary palliative procedures (arterial–pulmonary shunt, stenting of the patent ductus arteriosus, or pulmonary artery banding)

     
  2. 2.

    “Physiological correction,” preserving the right ventricle as a systemic ventricle and correcting only the associated lesions

     
  3. 3.

    “Anatomic correction,” utilizing the left ventricle as the systemic pumping chamber and the mitral valve as the systemic atrioventricular valve

     
  4. 4.

    Single-ventricle pathway that leaves both ventricles connected to the systemic circuit, providing systemic venous to the pulmonary arterial circuit by modified Fontan procedure

     

Keywords

Patent Ductus Arteriosus Ventricular Septal Defect Great Artery Pulmonary Atresia Situs Inversus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Supplementary material

Clip 1: The inferior vena cava is cannulated as low down as possible and somewhat laterally to preserve the Eustachian valve. Myocardial protection is provided by crystalloid antegrade cardioplegia.

Clip 1: Preoperative findings.

Clip 2: After subtotal removal of the thymus and harvesting of the pericardium, the external anatomy is examined closely.

Clip 3: The right atrium is opened in an oblique fashion.

Clip 4: Resection of the subpulmonary obstruction.

Clip 5: Evaluation of the left ventricular outflow tract.

Clip 6: Excision of the interatrial septum and opening of the entrance of the right pulmonary veins. Evaluation of the intra-atrial anatomy.

Clip 7: Development of the posterior wall of the systemic venous baffle with a trapezoid-shaped GORE-TEX© patch.

Clip 8: The anterior wall of the systemic venous baffle is developed.

Clip 9: Development of the pulmonary venous atrium using pericardium in situ (Shumaker modification).

Clip 10: Both great vessels are transected.

978-3-642-24169-7_2_MOESM12_ESM.mp4 (46.1 mb)
Clip 11: Harvesting of the buttons of the right and left coronary arteries.

Clip 12: Implantation of the left coronary artery button.

Clip 13: Implantation of the right coronary artery button.

Clip 14: Lecompte maneuver and reconstruction of the ascending aorta.

Clip 15: Reconstruction of the neopulmonary trunk with an autologous pericardial patch that has been pretreated with glutaraldehyde for 15–20 min.

Clip 16: Final result.

Clip 17: Postoperative echocardiogram findings.

Fullversion

Clip 1: As part of the double switch procedure, when the systemic venous baffle is completed, the ventricular septal defect is approached by working through the mitral valve. All sutures should be placed from the left side of the septum due to the variability of the conduction system, and one never knows if the conduction system travels along the anterosuperior margin of defect only or if there is a conduction sling. Alternatively, one could consider closing the ventricular septal defect by working through the right ventriculotomy or through the aorta, thus eliminating undue tension on the crux cordis.

Clip 1: Preoperative findings.

Clip 2: External anatomy of the heart.

Clip 3: Opening of the right atrium and development of the systemic venous baffle.

Clip 4: Completion of the systemic venous baffle.

Clip 5: Development of the pulmonary venous atrium using in situ pericardium.

Clip 6: Creation of the intraventricular baffle.

Clip 7: Placement of the conduit.

Clip 8: Postoperative findings.

Fullversion

Clip 1: Preoperative findings.

Clip 2: External anatomy of the heart.

Clip 3: Transection of the stented duct and mobilization of the pulmonary arteries.

Clip 4: Oblique opening of the left-sided atrium and resection of the interatrial septum.

Clip 5: Development of the posterior wall of the systemic venous baffle with a trapezoid-shaped GORE-TEX© patch.

Clip 6: The anterior wall of the systemic venous baffle is developed.

Clip 7: Development of the pulmonary venous atrium using pericardium in situ.

Clip 8: Evaluation of intracardiac anatomy.

Clip 9: Creation of the intraventricular baffle.

Clip 10: Stent resection and placement of the conduit.

Clip 11: Postoperative findings.

Fullversion

Clip 1: Preoperative findings.

Clip 2: The interatrial septum is resected. Using a short, longitudinally opened GORE-TEX© prosthesis, the inferior vena cava is tunneled toward the left-sided tricuspid valve, incorporating the coronary sinus inside the tunnel.

Fullversion

Clip 1: 8. Angiography 1 year after surgery

Recommended Reading

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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Viktor Hraška
    • 1
  • Peter Murín
    • 1
  1. 1.Department of Cardiac SurgeryGerman Pediatric Heart Centre, Sankt AugustinSankt AugustinGermany

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