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Ann Thorac Surg 1995;59:517-518
© 1995 The Society of Thoracic Surgeons

Invited Commentary

Invited Commentary

Hisashi Nikaidoh, MD

Children's Medical Center 1935 Motor St Dallas, TX 75235

See also page 515.

Doctor Kandeel and associates reported another successful aortic translocation operation in a well-selected patient with D-TGA associated with VSD and LVOTO. Previously, The Annals published one success in an infant in July 1986.

Based on my personal experience in 12 cases of aortic translocation operation, it appears that patient selection is the most important factor for surgical success. The preferred features are (1) weight of 10 kg or greater; (2) severe LVOTO consisting of hypoplastic pulmonary annulus, subpulmonic tunnel, or both; and (3) coronary artery anatomy that allows posterior movement of aortic root. All 12 patients are alive and well, although the operative morbidity is not minor. One patient had a late reoperation for obstruction of the pulmonary artery at the distal end of the right ventricular outflow tract pericardial patch. Presently, 4 patients have a pulmonary artery homograft within their right ventricular outflow tract. The Lecompte maneuver was not performed in any of these 12 patients.

Doctor Kandeel and associates used a pulmonary artery homograft for the reconstruction of the right ventricular outflow tract. Physiologically and anatomically, this is a logical approach. Although the size of this graft was not described in the report, a smaller homograft, which may be appropriate for a growing child, will present right ventricular outflow tract obstruction in the near future, as experienced in 1 of my earlier patients. The Lecompte maneuver, which requires unnecessary aortic transection and reanastomosis, could have been avoided, especially when a pulmonary artery homograft can easily make connection to the native pulmonary artery bifurcation on either side of the aorta.


Related Article

Aortic Translocation for D-TGA Associated With LVOTO and VSD
Mohammad Kandeel, Naresh Kumar, Ganga Prabhakar, Zohair Al-Halees, and Carlos M. G. Duran
Ann. Thorac. Surg. 1995 59: 515-517. [Abstract] [Full Text]




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