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J Thorac Cardiovasc Surg 2003;125:974
© 2003 The American Association for Thoracic Surgery

Letters to the Editor

Rastelli repair for transposition of the great arteries

Christian Kreutzer, MD

Instructor in Cardiovascular Surgery, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina

To the Editor:

I read with interest the letter from LecompteGo 1 regarding the article "Twenty-five-year experience with Rastelli repair for transposition of the great arteries."Go 2 Although the letter was elegantly answered by my mentor in the Rastelli project, I believe there are a few points that need further clarification.

Lecompte claims that I am confused regarding the differences between a Lecompte maneuver and a Lecompte procedure. I consider that the concept that Rastelli brought into our field was a breakthrough discovery. The ventricular septal defect baffling from the left ventricle to the aorta is the main concept in the correction of transposition, ventricular septal defect, and pulmonary stenosis or atresia. I do not believe that resection of the conal septum or of the anterosuperior margin of the defect is of such importance to merit a new name of a procedure. Likewise, the way in which right ventricular-pulmonary arterial continuity is established can be another modification of the original Rastelli procedure. These are really accessories of the main concept: ventricular septal defect baffling from the left ventricle to the aorta and establishment of right ventricular-pulmonary artery continuity.

Like Lecompte, I believe that modifications or even more reappraisals of the original Rastelli technique for correction of tetralogy of Fallot and pulmonary atresia with autologous fresh pericardiumGo 3 can be and should be taken into consideration for repair of transposition, ventricular septal defect, and pulmonary stenosis or atresia. For example, our experience with Rastelli procedures with autologous fresh pericardial valved conduits was presented in several meetings and articles.Go Go 4,5 The late results are spectacular, with a freedom from reoperation and a survival of more than 80% at 15 years.

This is another alternative to the "classic" Rastelli operation. I believe that the operation proposed by Gian Carlo Rastelli is here to stay, with all the modifications that will allow improvements in survival and reoperation rates.

References

  1. Lecompte Y. Rastelli repair for transposition of the great arteries: still the best choice [letter]? J Thorac Cardiovasc Surg. 2002;123:192-3.[Free Full Text]
  2. Kreutzer C, Gauvreau K, de Vivie J, Oppido G, Kreutzer J, Freed MF, et al. Twenty-five-year experience with Rastelli repair for transposition of the great arteries. J Thorac Cardiovasc Surg. 2000;120:211-23.[Abstract/Free Full Text]
  3. Rastelli GC, Ongley PA, Davis GD, Kirklin JW. Surgical repair for pulmonary valve atresia with coronary pulmonary fistula: report of a case. Mayo Clin Proc. 1965;40:521-7.[Medline]
  4. Schlichter AJ, Kreutzer C, Mayorquim R, Simon JL, Vazquez H, Roman MI, et al. Long term follow up of autologous pericardial valved conduits. Ann Thorac Surg. 1996;62:155-60.[Abstract/Free Full Text]
  5. Schlichter AJ, Kreutzer C, Mayorquim R, Simon JL, Roman MI, Vazquez H, et al. Five to fifteen year follow-up of autologous pericardial valved conduits. J Thorac Cardiovasc Surg. 2000;119:869-79.[Abstract/Free Full Text]




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