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Published on: November 2, 2019
Aortic translocation using the hemi-mustard procedure for corrected transposition
Akio Ikai1, Junichi Koizumi, Hajime Kin
1Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center, Morioka, Japan. a_ikai@imu.ncvc.go.jp
Insights
Congenitally corrected transposition of the great arteries (ccTGA) management is complex. A novel aortic translocation technique using the hemi-Mustard procedure prevents left ventricular outflow obstruction in specific ccTGA cases.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Congenitally corrected transposition of the great arteries (ccTGA) presents unique surgical challenges.
- Standard double switch procedures are contraindicated in ccTGA with restrictive ventricular septal defects and mild pulmonary stenosis due to risks of left ventricular outflow tract obstruction.
Observation:
- A specific case of ccTGA with these contraindications was identified.
- The patient underwent a preparatory phase of left ventricular training.
Findings:
- Aortic translocation, utilizing the hemi-Mustard procedure, was successfully performed.
- This approach effectively prevented postoperative left ventricular outflow tract obstruction.
Implications:
- This surgical strategy offers a viable alternative for complex ccTGA cases previously deemed inoperable with standard techniques.
- It expands the surgical options for managing ccTGA, potentially improving outcomes for affected children.
Abstract:
The management of congenitally corrected transposition of the great arteries and associated lesions is frequently challenging. Restrictive ventricular septal defect and mild pulmonary stenosis are contraindications to the double switch procedure, including the atrial-Rastelli switch procedure, due to the production of postoperative left ventricular outflow tract obstruction. We describe a case of aortic translocation using the hemi-Mustard procedure after left ventricular training in order to prevent postoperative left ventricular outflow obstruction.
