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The Journal of Thoracic and Cardiovascular Surgery, Vol 84, 727-733, Copyright © 1982 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Y Lecompte, JY Neveux, F Leca, L Zannini, TV Tu, Y Duboys and MM Jarreau
New techniques of correction of complex congenital anomalies, avoiding the
use of prosthetic conduits, are presented. In transposition of the great
arteries (TGA) with ventricular septal defect (VSD) and pulmonary stenosis,
the technique comprised the resection of infundibular septum, the suturing
of an intraventricular baffle directing blood from the left ventricle to
the aorta, and the reconstruction of the pulmonary outflow tract by direct
implantation of the posterior rim of the pulmonary arterial trunk on the
right ventricle, completed by an anterior patch. In most cases, the
pulmonary bifurcation was translated anterior to the ascending aorta. This
technique was feasible even in infants and in patients with a small VSD.
Thirteen patients, from 3 months to 8 years of age, were treated by this
technique, with four deaths, one residual VSD (reoperated), and eight good
results (4 to 16 months). A similar repair was used in three cases of
double-outlet right ventricle (DORV) with subpulmonic VSD and pulmonary
stenosis or pulmonary artery banding, with two operative deaths and one
good result. The same technique of pulmonary outflow tract reconstruction
was used in four cases of truncus arteriosus. Two deaths were attributed to
severe pulmonary regurgitation, a complication which should be prevented in
future cases by a reliable method of inserting a valve in the pulmonary
outflow tract. In pulmonary atresia with VSD and absent pulmonary trunk,
the continuity between the right ventricle and the pulmonary branches was
established via an arterial tube resected from the ascending aorta. This
technique was successfully used in one child with extremely small pulmonary
branches. These preliminary results led us to conclude that many complex
congenital cardiac anomalies can be effectively treated without a
prosthetic conduit.
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Reconstruction of the pulmonary outflow tract without prosthetic conduit
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