"Complex Aortic Valve Repair after en-Bloc Rotation of the Outflow Tracts" - Case Report

The En-bloc Rotation of the Outflow Tracts, as suggested by Anderson in 2016(1) is a surgical approach for complex congenital heart defects, particularly in patients with transposition of the great arteries (TGA) and associated ventricular septal defect (VSD) and left ventricular outflow tract (LVOT) obstruction (LVOTO). Despite its effectiveness, concerns have arisen following a study by Stoica et al.(2022), which reported that 16% of patients developed at least moderate aortic regurgitation (AR) post-surgery. The mechanisms behind this complication remain unclear. This case report presents a 4-year-old patient who developed significant AR (grade 3+/4), with left ventricular dilation (LVEDD : 43 mm), three years after an En-bloc Rotation, necessitating aortic valve repair. Initial echocardiography showed trivial AR, with progression of AR within 18 months and associated annular dilation (24 mm). The repair procedure involved plication of the left ventricular outflow tract (LVOT), annuloplasty, and leaflet adjustments. At discharge, residual AR was mild to moderate (1+/4). Seven months later, echocardiography revealed stable left ventricular dimensions and moderate AR (grade : 2+/4). This case emphasizes the need for early detection and intervention for AR in patients after En-bloc Rotation surgery. Further research is needed to identify predisposing factors and refine surgical strategies.