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Ann Thorac Surg 2001;72:180-181
© 2001 The Society of Thoracic Surgeons
e-mail: antonio.corno{at}chuv.hospvd.ch
When discussing the surgical treatment of anomalous ventriculoarterial connections it is important to clarify the difference between the Lecompte maneuver and the Lecompte procedure. The Lecompte maneuver is the translocation of the pulmonary artery bifurcation in a position anterior to the ascending aorta, as in normal hearts; the Lecompte maneuver is used during the arterial switch operation (or Jatene operation) for transposition of the great arteries, particularly when the great arteries are more or less anteroposterior and not side by side. To avoid the need for reoperation in children undergoing repair for ventriculoarterial discordance with ventricular septal defect and subpulmonary stenosis, Lecompte has proposed the Lecompte procedure (described by Dr Lecompte himself as "réparation à l’etage ventriculaire," or REV, with the sound similar to "rêve," the French word for dream), which basically means repair at the ventricular level [1].
The Lecompte procedure consists of (1) resection of the outlet septum, creating an unobstructed and direct subarterial communication between the left ventricle and the aorta; (2) intraventricular partition with construction of a straight tunnel from the left ventricle to the aorta; (3) positioning of the pulmonary artery anterior to the ascending aorta (the Lecompte maneuver) after transection of the ascending aorta and resection of a generous portion of the ascending aorta; and (4) direct anastomosis of the pulmonary trunk to the right ventricle without conduit interposition, with a monocusp patch as a new roof for the right ventricular outflow tract.
The actual advantages of this technique are the possibility of creating a connection from the left ventricle to the aorta free from residual or recurrent obstruction, independent from preoperative anatomy, due to the resection of the outlet septum; and the possibility of avoiding the implantation of an extracardiac valved conduit because of the direct anastomosis of the pulmonary trunk to the right ventricle. These two technical aspects are the keystones of the Lecompte procedure, and justify the hope of overcoming the drawbacks of the Rastelli operation.
Doctor Kim and colleagues decided not to use the Lecompte maneuver in all their cases, regardless of the relative position of the great arteries, and consequently, they did not transect a generous portion of the ascending aorta. Their operation should therefore be called a modified Lecompte procedure. In fact, they observed a high incidence of obstruction in the newly constructed right ventricular outflow tract (RVOT), possibly because the newly constructed RVOT remains relatively compressed and deviated laterally by the long aorta remaining in situ. The turbulence and vortex within the RVOT also may facilitate development of early obstruction or calcification of the monocusp patch, independent of the absent pressure gradients at the end of the surgical procedure or in the immediate postoperative period.
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