Long-term results of atrioventricular groove patch plasty--original method and its modification

Anatomically corrected malposition of great arteries (ACMGA) is associated with the leftward deviation of the proximal right coronary artery (RCA) away from the right atrioventricular (AV) groove. This anatomic feature allows a transannular subpulmonary patch plasty along the right AV groove between the RCA and the tricuspid annulus for relief of subpulmonary stenosis. This technique is also applicable to similar malformations that belong to the same spectrum. The long-term results of this original method and its modification were reviewed.

This surgical technique with a monocuspid transannular patch for subpulmonary stenosis was applied in 13 patients (seven patients with ACMGA, four patients with transposition of the great arteries after arterial switch operation (Shaher type 4 or 9) who underwent the original Konno or subaortic resection simultaneously, and two patients with discordant AV connection who have undergone conventional left ventricle to pulmonary artery repair or ventricular septation and pacemaker implantation previously). The mean age at operation was 15 years.

Postoperative catheterisation revealed adequate relief of pulmonary stenosis, with a pressure gradient of 5.6 ± 4.5 mmHg and with normalised right ventricular pressure (35 ± 12 mmHg). There was no late death or re-operation during a postoperative follow-up period of 90 ± 58 months. All patients were in normal sinus rhythm, postoperatively, except for 3 patients (one AV block due to subaortic resection, and two pacemaker rhythms implanted previously).

The present report describes the excellent long-term results of the AV groove patch plasty for subpulmonary stenosis in ACMGA and similar malformations by using morphological advantages. This technique provides a promising alternative to the Rastelli-type conduit repair.