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Intraventricular repair for Taussig-Bing anomaly
Y Kawashima1, H Matsuda, T Yagihara
1Division of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
Insights
Intraventricular rerouting repair is a feasible surgical option for Taussig-Bing anomaly, demonstrating no early or late deaths. This technique is effective for various patient ages and conal anatomy variations.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiac Anatomy
Background:
- Taussig-Bing anomaly is a complex congenital heart defect.
- Intracardiac repair is a common surgical approach.
- Intraventricular rerouting is a specific technique for repair.
Purpose of the Study:
- To evaluate the feasibility and outcomes of intraventricular rerouting repair in patients with Taussig-Bing anomaly.
- To assess the impact of patient age and conal anatomy on surgical results.
Main Methods:
- Retrospective analysis of 10 patients with Taussig-Bing anomaly undergoing intraventricular rerouting repair.
- Surgical technique involved extensive resection of the infundibular septum to create a subaortic route.
- Follow-up included echocardiography to assess pressure gradients and regurgitation.
Main Results:
- No early or late deaths were observed in the study group.
- One patient required reoperation for residual pulmonary stenosis.
- Intraoperative and postoperative left ventricular-aortic pressure gradients were within acceptable ranges.
- Age at operation and infundibular septum hypertrophy did not significantly affect outcomes.
Conclusions:
- Intraventricular rerouting repair is a viable and safe surgical option for Taussig-Bing anomaly, particularly in cases with side-by-side great arteries.
- The technique appears adaptable to different patient ages and conal anatomical variations.
Abstract:
Among 41 patients with Taussig-Bing anomaly who underwent intracardiac repair, 10 patients were treated by intraventricular rerouting repair. The ages at operation ranged form 1 month to 8 years (average 2 years 3 months). Primary repair was done in four (average age 2 years 7 months), and repair was done after pulmonary artery banding in six patients (average age 2 years 2 months). The relationship of the great arteries was side by side in nine patients and oblique in one. After extensive resection of the infundibular septum, a distance of 8 to 18 mm from the tricuspid ring or chordae to the pulmonary valve was obtained (24% to 71% of total circumference for the subaortic route). The subaortic route was created to obtain an internal diameter at least equal to that of the aortic route. Tricuspid chordal or papillary muscle reattachment was performed in two patients. There were no early or late deaths. Follow-up ranged from 1 year 4 months to 22 years 3 months (average 5 years 8 months), and reoperation was required in one patient for residual pulmonary stenosis. The intraoperative pressure gradient between the left ventricle and aorta was 0 to 24 mm Hg (average 10.3 mm Hg), and postoperative study showed the gradients to be less than 19 mm Hg (n = 8). The age at operation, left ventricular-aortic pressure gradient, and postoperative tricuspid regurgitation were not significantly affected by the presence of severe hypertrophy of the infundibular septum (n = 4). These results indicate that intraventricular rerouting may be feasible in most patients who have the Taussig-Bing anomaly with side-by-side or similar relationships of the great arteries, and the age and conal anatomic variations do not appear to be significant limiting factors.