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Modified arterial switch operation by sharing the common wall between the great arteries
1Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Summary
A modified arterial switch operation (ASO) using common wall and in situ transfer techniques reduced complications like coronary kinking and bleeding in infants with transposition of the great arteries.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Suprapulmonary stenosis and coronary artery obstruction are persistent challenges following arterial switch operation (ASO).
- A modified ASO procedure was developed to address these limitations.
Purpose of the Study:
- To evaluate the efficacy of a modified ASO using common wall and in situ transfer techniques.
- To reduce the incidence of suprapulmonary stenosis and coronary arterial obstruction post-ASO.
Main Methods:
- Eleven infants with transposition of the great arteries underwent a modified ASO between October 1996 and December 1997.
- The technique involved sharing the common wall between great arteries and in situ coronary artery redirection.
Main Results:
- No early deaths, coronary, or bleeding complications were observed.
- One late death occurred due to suprapulmonary stenosis; cleaning the common wall adventitia reduced stenosis in later cases.
- Ten patients showed good outcomes at long-term follow-up (mean 30.9 months).
Conclusions:
- The modified ASO with common wall and in situ transfer may prevent coronary kinking and decrease postoperative bleeding.
- Cleaning common wall adventitia and maintaining in situ positioning of pulmonary arteries are crucial for avoiding suprapulmonary stenosis.