Techniques to avoid injury of the conduction tissue during the surgical treatment of corrected transposition

Sequential atrioventricular conduction may be maintained during surgery in most patients with corrected transposition of the great arteries by operative techniques that include: (1) closure of the ventricular septal defect to the left side of the ventricular septum through a right atrial-right atrioventricular valve exposure, and (2) spiral pulmonary outflow patch (with or without pulmonary valve replacement), which enlarges the outflow tract posteriorly combined with posterior subvalvular resection of fibromuscular outflow tract obstruction. These techniques place operative manipulation posterior to the pulmonary anulus and on the left side of the septum so as to preserve the conduction tissue, which is located anterior to the pulmonary anulus and on the anterior rim of the ventricular septal defect in corrected transposition of the great arteries.