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J Thorac Cardiovasc Surg 2001;122:872-878
© 2001 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease (CHD)

Atrioventricular groove patch plasty for anatomically corrected malposition of the great arteries

From the Department of Cardiovascular Surgery, Jikei University School of Medicine, Tokyo, Japan.

Received for publication June 21, 2000. Revisions requested July 31, 2000; revisions received Jan 29, 2001. Accepted for publication March 28, 2001. Address for reprints: Hiromi Kurosawa, MD, 3-25-8 Nishi-shinbashi Minatoku, Tokyo 105-8461, Japan (E-mail: kurosawa{at}jikei.co.jp).

Abstract

Objective: In anatomically corrected malposition of the great arteries, dextroposition of the posterior pulmonary artery and levoposition of the anterior aorta are associated with the leftward deviation of the proximal portion of the right coronary artery away from the right atrioventricular groove. This anatomic feature allows a transannular subpulmonary patch plasty of the right ventricular outflow tract along the right atrioventricular groove between the right coronary artery and the tricuspid anterior anulus (ie, atrioventricular groove patch plasty) for relief of subpulmonary stenosis without jeopardizing the right coronary artery.
Methods: This report describes the midterm results of a new surgical technique, atrioventricular groove patch plasty with a monocuspid transannular patch for subpulmonary stenosis, in 3 patients with anatomically corrected malposition of the great arteries, along with a concomitant closure of ventricular septal defects.
Results: Postoperative catheterization revealed adequate relief of pulmonary stenosis, with a pressure gradient of 8.0 ± 3.5 mm Hg and with normalized right ventricular pressure (33 ± 10 mm Hg), contributing to excellent midterm results with no late death and reoperation during a postoperative follow-up period of 70 ± 47 months.
Conclusion: This technique provides a promising alternative to Rastelli-type conduit repair for subpulmonary stenosis in anatomically corrected malposition of the great arteries.

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