Right transatrial approach to relieve pulmonary stenosis in patients with corrected transposition of the great vessels: A new operation without use of an extracardiac conduit

J Ernesto Molina, Yang Wang, Arthur E. Stillman

Research output: Contribution to journalArticlepeer-review

Abstract

Background: A new operation to relieve pulmonary obstruction is proposed for patients with corrected transposition of the great vessels and pulmonary stenosis (PS). A right transatrial approach involves excising or detaching the right-sided atrioventricular valve (AV). Next, the pulmonary outflow tract is opened wide with an incision extending from the right-sided ventricle upward across the AV valve annulus. This incision extends into the main trunk of the pulmonary artery located behind the right atrium. A patch, with or without implantation of a pulmonary valve prosthesis, widens the outflow tract, thus avoiding use of an extracardiac conduit. Method: We describe this operation performed in a 51-year-old man who had previously undergone correction with an extracardiac conduit that had become obstructed. The patient had severe right-sided AV valve insufficiency and complete heart block with a functioning transvenous pacemaker. We replaced the right-sided AV valve and positioned the permanent pacemaker lead outside of the prosthetic skirt. The PS was corrected as described above and a pulmonary prosthetic valve implanted. Use of an extracardiac conduit was avoided altogether. Conclusion: This technique may be applicable even without excising the right-sided AV valve. The clinical result for our patient is still optimal 4 years after surgery.

Original languageEnglish (US)
Pages (from-to)411-417
Number of pages7
JournalJournal of Cardiac Surgery
Volume15
Issue number6
DOIs
StatePublished - Jan 1 2000

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