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J Thorac Cardiovasc Surg 2007;133:569-572
© 2007 The American Association for Thoracic Surgery

Brief Communication

Neoaortic root dilatation with saccular aneurysm formation after the arterial switch operation for Taussig–Bing anomaly

^a Cardiothoracic Surgery Unit, Monash Medical Centre, Clayton, Victoria, Australia
^b Department of Paediatric Cardiology, Monash Medical Centre, Clayton, Victoria, Australia
^c Department of Surgery (MMC), Monash University, Clayton, Victoria, Australia.

Received for publication September 12, 2006; accepted for publication September 19, 2006.

^_* Address for reprints: Julian A. Smith, MS, FRACS, Cardiothoracic Surgery Unit, Monash Medical Centre, 246 Clayton Rd, Clayton, Victoria 3168, Australia. (Email: julian.smith@med.monashi.edu.au).

The first 300 words of the full text of this article appear below.

Professor Smith and Dr Hayashi (left to right)

The arterial switch operation (ASO) has become the preferred procedure for repair of d-loop transposition of the great arteries, and this anatomic correction has been applied to the treatment of right ventricular dysfunction after atrial switch procedures, as well as primary curative repair in newborns. On the other hand, this operation involves radical manipulation of the base of the great arteries. Both great arteries are transected and reanastomosed above the sinuses of Valsalva, and the coronary arteries are translocated. The native pulmonary valve becomes the systemic outflow valve, and the anatomic pulmonary root is subjected to systemic blood pressure. Neoaortic root dilatation, which is one of the postoperative complications after ASO, is thought to occur as a result of these atypical hemodynamic and anatomic features.¹

Neoaortic root dilatation might be recognized during late follow-up,^2,3 and some patients might require a neoaortic root or valve operation at some stage after an ASO.^3,4 Careful assessment of the individual anatomic situation is essential before surgical repair because coronary artery distribution and the positional relationship of the great arteries affect the conduct of the operative procedure. We describe a case of neoaortic root dilatation accompanied by a huge saccular aneurysm, which was detected during pregnancy. The patient had undergone an ASO for Taussig–Bing anomaly (double-outlet right ventricle with subpulmonary ventricular septal defect) 14 years previously. We also discuss some of the important issues regarding the assessment of neoaortic root dilatation after an ASO.

Clinical Summary

The patient, a 26-year-old woman, was born with the Taussig–Bing anomaly accompanied by subpulmonary stenosis. She underwent a Senning operation at the age of 8 months as a radical repair after balloon atrial septostomy on her third day of life. At the age of 2.5 years, she subsequently had a resection . . . [Full Text of this Article]