Commissural Malalignment of Aortic-Pulmonary Sinus in Complete Transposition of Great Arteries
|
|
- Austen Norton
- 6 years ago
- Views:
Transcription
1 Commissural Malalignment of Aortic-Pulmonary Sinus in Complete Transposition of Great Arteries Soo-Jin Kim, MD, Woong-Han Kim, MD, Cheong Lim, MD, Sam Se Oh, MD, and Yang-Min Kim, MD Departments of Pediatric Cardiology, Cardiac Surgery, and Radiology, Sejong Heart Institute, Pucheon-City, Korea Background. Translocation of the coronary artery to the neoaorta is essential in the arterial switch operation. The goal of this study is to investigate (1) the frequency of commissural malalignment in complete transposition of the great arteries, (2) the usefulness of echocardiography in diagnosis of commissural malalignment, and (3) the impact of commissural malalignment on surgery. Methods. We retrospectively reviewed the medical records of 28 patients with complete transposition of the great arteries who underwent an arterial switch operation from February 2000 to August Results. Commissural malalignment was expected preoperatively in 11 patients by echocardiography and was confirmed in 13 patients intraoperatively. Four patterns of commissural malalignment were present: (1) sinusfacing of the pulmonary valve, (2) sinus-facing of the aortic valve, (3) sinus-facing of both valves, and (4) bicuspid pulmonary valve (functionally sinus-facing). Two patterns of severity were present: major and minor. To avoid torsion and stretching of the coronary arteries during surgery, various methods were needed: more extensive dissection of the coronary artery, trap door incision, supracommissural or juxtacommissural transfer, both coronary transfer to the same sinus, tube reconstruction of the coronary artery, and neoaorta dextrorotation anastomosis. One patient who had severe commissural malalignment died during the operation, and the cause of death was probably stretching or torsion of the coronary artery. Conclusions. The recognition of malalignment of the facing sinus in transposition of the great arteries can be detected preoperatively by echocardiography. The surgical procedure of the arterial switch operation is influenced by the presence of commissural malalignment. Preoperative awareness of commissural malalignment seems to be helpful for surgeons to predict the need for an alternative operational procedure. (Ann Thorac Surg 2003;76: ) 2003 by The Society of Thoracic Surgeons The most important part of the arterial switch procedure may be the successful translocation of the coronary arteries without producing either kinking or torsion. It is essential for the surgeon to recognize the origin and proximal course of the coronary arteries, the spatial relationship of the arterial trunks one to the other, and the morphology and function of the semilunar valves. It is often discovered that the commissure between coronary arterial sinuses is poorly aligned but this had not been elucidated in advance. The goal of this study is to investigate (1) the frequency of commissural malalignment of the aortic-pulmonary sinus in complete transposition of the great arteries (TGA), (2) the usefulness of echocardiography in preoperative detection of commissural malalignment, and (3) the impact of commissural malalignment on surgery. Patients and Methods We evaluated the facing of the semilunar sinuses and the alignment of the interostial commissure of the aortic and Accepted for publication June 6, Address reprint requests to Dr Soo-Jin Kim, Sejong Heart Institute, , Sosa-dong, Sosa-Ku Pucheon-city Kyunggi-do, Korea ; pulmonary valves by echocardiography, the mutual relationship of the orifices of the great arteries, the morphology of the semilunar valves, and the origin and course of the coronary arteries. Echocardiographic examination for evaluation of the semilunar valves was performed with classic views and especially with the en face view of both valves at high parasternal level (Fig 1). Twenty-eight patients with TGA who visited our institution between February 2000 and August 2001 and 13 (46%) patients who have commissural malalignment of two arterial valves were evaluated. All patients received the arterial switch operation. All operations were performed by the same surgeon (W.H.K.). Analysis of the alignment of the commissures was classified into four patterns by sinus-facing valve or rotation of the semilunar valve (Fig 2) and classified into two patterns by severity of commissural malalignment (Fig 3). Patterns by sinus-facing valve or rotation of the semilunar valve were sinus-facing of the pulmonary valve, sinus-facing of the aortic valve, sinus-facing of both valves, and bicuspid valve (functionally sinusfacing). We decided that the semilunar valve that the commissure is not in the line of crossing between the centers of both semilunar valves is a rotated or malposi by The Society of Thoracic Surgeons /03/$30.00 Published by Elsevier Inc doi: /s (03)
2 Ann Thorac Surg KIM ET AL 2003;76: COMMISSURAL MALALIGNMENT IN TGA 1907 Fig 1. Echocardiographic view showing commissural malalignment (sinus-facing pattern of pulmonary valve [PV]). (AV aortic valve.) tioned valve. Patterns by severity of commissural malalignment were major and minor malalignment. Results Among the 13 commissural malalignment patients, there were 9 boys and 4 girls. Their ages ranged from 2 to 46 days (mean, 17.5 days), and the weight ranged from 2.8 to 5.1 kg (mean, 3.6 kg). Ten patients underwent surgery with echocardiography only and without cardiac catheterization and angiography. In the other 3 patients, catheterization and angiography for balloon atrial septostomy were performed. Commissural malalignment was detected preoperatively by echocardiography and confirmed intraoperatively in 11 patients. Commissural malalignment was detected at the operative field in the other 2 patients. Patterns by sinus-facing valve or rotation of the semilunar valve were sinus-facing of the pulmonary valve in 7 patients, sinus-facing of the aortic valve in 2 patients, sinus-facing of both valves in 2 patients, and bicuspid valve (functionally sinus-facing) in 2 patients. Patterns by Fig 3. Malalignment pattern according to severity of malalignment. (A) Minor (n 5). (B) Major (n 8). severity of commissural malalignment were 8 patients in major and 5 patients in minor malalignment. In the cases in which the interostial commissure is poorly aligned, we were faced with a dilemma of classifying the sinuses (Fig 4). In the presence of sinus-facing of the aortic valve, there were two nonfacing sinuses. Therefore, we could not decide the stance site of an observer looking toward the pulmonary trunk and leftfacing or right-facing sinus. We analyzed the position of the great arteries and the coronary arterial pattern in patients with commissural malalignment. Other positions of the great arteries except the right anterior aorta and complex coronary anat- Fig 2. Malalignment pattern according to sinus-facing valve or rotated valve. (A) Sinus-facing of the pulmonary valve (n 7). (B) Sinus-facing of the aortic valve (n 2). (C) Sinus-facing of both valves (n 2). (D) Bicuspid pulmonary valve (n 2).
3 1908 KIM ET AL Ann Thorac Surg COMMISSURAL MALALIGNMENT IN TGA 2003;76: Table 2. Coronary Arterial Patterns in Patients With Commissural Malalignment Coronary Arterial Patterns Number of Patients (%) LAD, LCX from sinus 1, RCA from sinus 2 4/13 (31%) LAD from sinus 1, RCA, LCX from sinus 2 3/13 (25%) None from sinus 1, LAD, LCX, RCA from 4/13 (31%) sinus 2 Dual LAD 2/13 (15%) RCA, LAD from sinus 1, LCX, LAD 1 from sinus 2 LAD from sinus 1, RCA, LCX, LAD 1 from sinus 2 LCX left circum- LAD left anterior descending coronary artery; flex artery; RCA right coronary artery. Fig 4. Dilemma for classification of sinus. (L left; R right.) omy with abnormal courses may be frequent in TGA with commissural malalignment (Tables 1, 2). Other complexity factors of the arterial switch operation were marked discrepancy of the great arteries in 3 patients, single coronary arteries in 2 patients, side-byside relationship of the great arteries in 2 patients, and TGA with posterior aorta in 1 patient. All patients underwent the arterial switch operation. Because of the long distance for coronary transfer, many techniques were needed to avoid kinking or torsion of the coronary arteries. All patients required more extensive dissection of the coronary arteries than usual, and a trap door incision was required in 10 patients. Five patients underwent coronary transfer to a supracommissural or juxtacommissural site because of kinking or torsion of the coronary arteries. Four patients underwent transfer of two coronary artery systems to the same sinus also for the same reason. Also, tube reconstruction of the coronary artery was performed in 1 patient (Fig 5). In 1 patient, a neoaorta dextrorotation anastomosis was performed to avoid stretching of the coronary arteries. One patient died immediately after the arterial switch operation. He had a TGA with posterior aorta, severe commissural malalignment of the semilunar valves, and an unusual coronary artery pattern (right coronary artery Table 1. Great Arterial Patterns in Patients With Commissural Malalignment Great Arteries Patterns (AV relative to PV) Commissural Malalignment (%) Anterior and to the right 8/13 (53%) Side-by-side, aorta to right 2/13 (15%) Directly anterior 2/13 (15%) Posterior and to the right 1/13 (7%) AV aortic valve; PV pulmonary valve. and left anterior descending coronary artery from sinus 1, left circumflex artery and left anterior descending coronary artery from sinus 2; dual left anterior descending coronary arteries). After an uneventful surgical procedure, sudden cardiac arrest developed at the intensive care unit. The cause of death was suggested to be that during the postoperative period of the intensive care unit, the great arterial walls were stretched as intracardiac blood volume increased and the coronary artery was compressed. This probably resulted in coronary insufficiency and death. The other 12 patients are doing well and none has ventricular dysfunction or significant neoaortic regurgitation. Comment The arterial switch operation is now the established method of repair for complete transposition and related lesions. Unfavorable patterns of coronary arterial distribution may be the single most important risk factor for performing this procedure. The cause of most early deaths appears to be related to difficulties encountered during the transfer of the coronary arteries [1]. Many large series stress the importance of safe transfer of the coronary arteries as the essence of a good switch operation [2 8]. They further emphasize the pitfalls inherent in not recognizing the more complex coronary arterial patterns. The commissure of two semilunar valves was often not in line: this malalignment varied from a minor deviation of the commissure in relation to that of the opposite valve, to a position in which the commissure between the two facing sinuses of one valve was opposed to the middle of a sinus of the opposite valve. Analysis of the alignment of the commissure revealed four patterns and severity of malalignment. The previous reports revealed that the incidence of commissural malalignment is from 13% to 35%, and our report reveals that the incidence is relatively higher (46%) than the previous reports [9, 10]. Also, most of our cases (11 of 13 patients) could be detected preoperatively. In the report by Massoudy and colleagues [10], the malalignment was more frequent in side-by-side vessels.
4 Ann Thorac Surg KIM ET AL 2003;76: COMMISSURAL MALALIGNMENT IN TGA 1909 Fig 5. Modification of surgical method for coronary transfer to avoid tension or torsion. (A) Transfer to the same sinus. (B) Tube reconstruction. (C) Supracommissural transfer. (D) Transfer to the same sinus in the bicuspid pulmonary valve. Also, other positions of the great arteries except the right anterior aorta and complex coronary anatomy with abnormal courses may be frequent in TGA with commissural malalignment in our cases. While studying the aortic semilunar sinuses, we encountered a problem with regard to the terminology in use for three aortic sinuses. Usually, in TGA the aortic sinuses are designated as right-facing sinus, left-facing sinus, and nonfacing sinus by the nomenclature of Anderson and Becker [11]. They were described as seen from the stance of an observer in the nonadjacent aortic sinus looking toward the pulmonary trunk. In two of our cases, it is confusing to use nomenclature for sinus-facing aortic valves (Fig 4). For example, in cases of sinus-facing aortic valve, there were two nonfacing sinuses, and we could not decide which was the right-facing or left-facing sinus. Uemura and colleagues [12] have discussed the significance of the bicuspid pulmonary valve (functionally sinus-facing) in the arterial switch procedure. They speculated that the direction of the commissure between the two leaflets of the initial pulmonary valve, at right angles to the commissure between the facing aortic leaflets, might have restricted the potential site of anastomosis between the coronary arterial buttons and the neoaorta. Commissural malalignment may not be an absolute risk factor, but in cases combined with abnormal coronary arterial course, it can be a high risk factor. Also, it requires various surgical techniques when coronary transfer is performed In conclusion, our reports reveal that commissural malalignment is often discovered in complete TGA, and it can be detected by preoperative echocardiography. Therefore, we suggest that this commissural malalignment should alert the surgeons to a potentially difficult reimplantation of the coronary arteries. It may also predicate the need for an alternative operative procedure. References 1. Kirklin JW. The surgical repair for complete transposition. Cardiol Young 1991;1: Quagebeur JM, Rohmer J, Buis T, Kirklin JW, Blacstone EH, Brom AG. The arterial switch operation. An eight-year experience. J Thorac Cardiovasc Surg 1986;92: Norwood W, Dobell A, Freed M, Kirklin JW, Blackstone E, and the Congenital Heart Surgeons Society. Intermediate results of the arterial switch repair. J Thorac Cardiovasc Surg 1988;96: Castaneda AR, Norwood WI, Jonas RA, Colon SD, Sanders SP, Lang P. Transposition of the great arteries and intact ventricular septum: anatomical repair in the neonate. Ann Thorac Surg 1984;38: Planche C, Bruniaux J, Lacour-Grayet F. Switch operation for transposition of the great arteries in neonates; a study of 120 patients. J Thorac Cardiovasc Surg 1988;96: Day RW, Laks H, Drinkwater DC. The influence of coronary anatomy on the arterial switch operation in neonates. J Thorac Cardiovasc Surg 1992;104: Yamaguchi M, Hosokawa Y, Imai Y, et al. Early and midterm results of the arterial switch operation for transposition
5 1910 KIM ET AL Ann Thorac Surg COMMISSURAL MALALIGNMENT IN TGA 2003;76: of the great arteries in Japan. J Thorac Cardiovasc Surg 1990;100: Mayer JE, Sanders SP, Jonas RA, Castaneda AR, Wernovsky G. Coronary artery pattern and outcome of the arterial switch operation for transposition of the great arteries. Circulation 1990;82(Suppl 4):IV Gittenberger DR, Ursula S, Arentje OD, Jan Q. Coronary arterial anatomy in transposition of the great arteries: a morphologic study. Pediatr Cardiol 1983;4(Suppl 1): Massoudy P, Baltalarli A, de Leval MR, et al. Anatomic variability in coronary arterial distribution with regard to the arterial switch procedure. Ciculation 2002;106: Anderson RH, Becker AE. Coronary arterial patterns: a guide to identification of congenital heart disease. In: Becker AE, Losekoot G, Anderson RH, eds. Pediatric cardiology, 3rd ed. Edinburgh: Churchill Livingstone, 1981: Uemura H, Yagihara T, Kawashima Y, et al. A bicuspid pulmonary valve is not a contraindication for the arterial switch operation. Ann Thorac Surg 1995;59: Notice From the American Board of Thoracic Surgery The 2004 Part I (written) examination will be held at the Sofitel O Hare Hotel, Rosemont, Chicago, IL, on November 21, The closing date for registration is August 1, Those wishing to be considered for examination must request an application because it is not automatically sent. To be admissible to the Part II (oral) examination, a candidate must have successfully completed the Part I (written) examination. A candidate applying for admission to the certifying examination must fulfill all the requirements of the Board in force at the time the application is received. Please address all communications to the American Board of Thoracic Surgery, One Rotary Center, Suite 803, Evanston, IL 60201; telephone: (847) ; fax: (847) ; info@abts.org by The Society of Thoracic Surgeons Ann Thorac Surg 2003;76: /03/$30.00 Published by Elsevier Inc
The arterial switch operation has been the accepted procedure
The Arterial Switch Procedure: Closed Coronary Artery Transfer Edward L. Bove, MD The arterial switch operation has been the accepted procedure for the repair of transposition of the great arteries (TGA)
More informationTGA Surgical techniques: tips & tricks (Arterial switch operation)
TGA Surgical techniques: tips & tricks (Arterial switch operation) Seoul National University Children s Hospital Woong-Han Kim Surgical History 1951 Blalock and Hanlon, atrial septectomy 1954 Mustard et
More informationSince first successfully performed by Jatene et al, the
Long-Term Predictors of Aortic Root Dilation and Aortic Regurgitation After Arterial Switch Operation Marcy L. Schwartz, MD; Kimberlee Gauvreau, ScD; Pedro del Nido, MD; John E. Mayer, MD; Steven D. Colan,
More informationFATE OF THE NEOPULMONARY VALVE AFTER THE ARTERIAL SWITCH OPERATION IN NEONATES
FATE OF THE NEOPULMONARY VALVE AFTER THE ARTERIAL SWITCH OPERATION IN NEONATES Shunji Nogi, MD a Brian W. McCrindle, MD, FACC a Christine Boutin, MD a William G. Williams, MD, FACC b Robert M. Freedom,
More informationWill we face a big problem with the aortic valve/root after ASO?
Will we face a big problem with the aortic valve/root after ASO? Laurence Iserin Unité médico-chirurgicale de Cardiologie Congénitale Adulte Hôpital Universitaire Européen Georges Pompidou APHP, Université
More informationNeonatal arterial switch operation: coronary artery patterns and coronary events 1
European Journal of Cardio-thoracic Surgery 11 (1997) 810 817 Neonatal arterial switch operation: coronary artery patterns and coronary events 1 Daniel Tamisier, Ruth Ouaknine, Philippe Pouard, Philippe
More informationTransposition of the great arteries in the fetus: assessment of the spatial relationships of the arterial trunks by four-dimensional echocardiography
Ultrasound Obstet Gynecol 2008; 31: 271 276 Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.5276 Transposition of the great arteries in the fetus: assessment of the
More informationThe Rastelli procedure has been traditionally used for repair
En-bloc Rotation of the Truncus Arteriosus A Technique for Complete Anatomic Repair of Transposition of the Great Arteries/Ventricular Septal Defect/Left Ventricular Outflow Tract Obstruction or Double
More informationAnatomy of the coronary arteries in transposition
Thorax, 1978, 33, 418-424 Anatomy of the coronary arteries in transposition of the great arteries and methods for their transfer in anatomical correction MAGDI H YACOUB AND ROSEMARY RADLEY-SMITH From Harefield
More informationCoronary Arterial Anatomy in Double-Outlet Right Ventricle With Subpulmonary VSD
Coronary Arterial Anatomy in Double-Outlet Right Ventricle With Subpulmonary VSD Hideki Uemura, MD, Toshikatsu Yagihara, MD, Yasunaru Kawashima, MD, Kyoichi Nishigaki, MD, Tetsuro Kamiya, MD, Siew Yen
More informationMid-term Result of One and One Half Ventricular Repair in a Patient with Pulmonary Atresia and Intact Ventricular Septum
Mid-term Result of One and One Half Ventricular Repair in a Patient with Pulmonary Atresia and Intact Ventricular Septum Kagami MIYAJI, MD, Akira FURUSE, MD, Toshiya OHTSUKA, MD, and Motoaki KAWAUCHI,
More informationCurrent Technique of the Arterial Switch Procedure for Transposition of the Great Arteries
Current Technique of the Arterial Switch Procedure for Transposition of the Great Arteries EDWARD L. BOVE, M.D. Section of Thoracic Surgev, C.S. Mott Children's Hospital, The University of Michigan Medical
More informationCoronary Artery from the Wrong Sinus of Valsalva: A Physiologic Repair Strategy
Coronary Artery from the Wrong Sinus of Valsalva: A Physiologic Repair Strategy Tom R. Karl, MS, MD he most commonly reported coronary artery malformation leading to sudden death in children and young
More informationCoronary Artery Obstruction After the Arterial Switch Operation for Transposition of the Great Arteries in Newborns
202 JACC Vol. 29, No. 1 Coronary Artery Obstruction After the Arterial Switch Operation for Transposition of the Great Arteries in Newborns PHILIPP BONHOEFFER, MD, DAMIEN BONNET, MD, JEAN-FRANÇOIS PIÉCHAUD,
More informationThe Arterial Switch Operation for Transposition of the Great Arteries
The Arterial Switch Operation for Transposition of the Great Arteries Jan M. Quaegebeur, M.D., Ph.D. A Journey of 60 Years Transposition of the Great Arteries First description: M. BAILLIE The morbid anatomy
More informationThe Arterial Switch Operation at 40: Not As Good As It Gets?
The Arterial Switch Operation at 40: Not As Good As It Gets? Gil Wernovsky, MD, FAAP, FACC Senior Consultant in Cardiology and Cardiac Critical Care Professor of Pediatrics Children s National Health System
More informationRecent technical advances and increasing experience
Pediatric Open Heart Operations Without Diagnostic Cardiac Catheterization Jean-Pierre Pfammatter, MD, Pascal A. Berdat, MD, Thierry P. Carrel, MD, and Franco P. Stocker, MD Division of Pediatric Cardiology,
More informationPrimary Arterial Switch Operation for Transposition of the Great Arteries With Intact Ventricular Septum in Infants Older Than 21 Days
883 Primary Arterial Switch Operation for Transposition of the Great Arteries With Intact Ventricular Septum in Infants Older Than 21 Days JOHN P. FORAN, MRCP, IAN D. SULLIVAN, FRACP, MARTIN J. ELLIOTT,
More informationBay Window Technique for the Arterial Switch Operation of the Transposition of the Great Arteries With Complex Coronary Arteries
Bay Window Technique for the Arterial Switch Operation of the Transposition of the Great Arteries With Complex Coronary Arteries Masaaki Yamagishi, MD, Keisuke Shuntoh, MD, Katsuji Fujiwara, MD, Takeshi
More informationDouble Outlet Right Ventricle with Anterior and Left-Sided Aorta and Subpulmonary Ventricular Septal Defect
Case Report Double Outlet Right Ventricle with Anterior and Left-Sided rta and Subpulmonary Ventricular Septal Defect Luciana Braz Peixoto, Samira Morhy Borges Leal, Carlos Eduardo Suaide Silva, Sandra
More informationCongenital heart disease involving the coronary artery
Anomalous Coronary Artery With Aortic Origin and Course Between the Great Arteries: Improved Diagnosis, Anatomic Findings, and Surgical Treatment Eldad Erez, MD, Vincent K. H. Tam, MD, Nancy A. Doublin,
More informationAnatomic variants of the normal coronary artery circulation
Diagnosis and Operation for Anomalous Circumflex Coronary Artery Keishi Ueyama, MD, PhD, Mahesh Ramchandani, MD, Arthur C. Beall, Jr, MD, and James W. Jones, MD, PhD Department of Surgery, Baylor College
More informationTransposition of the Great Arteries Preoperative Diagnostic Considerations. John Simpson Evelina Children s Hospital London, UK
Transposition of the Great Arteries Preoperative Diagnostic Considerations John Simpson Evelina Children s Hospital London, UK Areas to be covered Definitions Scope of occurrence of transposition of the
More information3 Aortopulmonary Window
0 0 0 0 0 Aortopulmonary Window Introduction Communications between the ascending aorta and pulmonary artery constitute a spectrum of malformations which is collectively designated aortopulmonary window,
More informationThe Double Switch Using Bidirectional Glenn and Hemi-Mustard. Frank Hanley
The Double Switch Using Bidirectional Glenn and Hemi-Mustard Frank Hanley No relationships to disclose CCTGA Interesting Points for Discussion What to do when. associated defects must be addressed surgically:
More informationC congenital cardiac anomaly in which there is a
Coronary Artery Anatomy in Complete Transposition of the Great Arteries Eugene K. W. Sim, FRCS, Jacques A. M. van Son, MD, PhD, William D. Edwards, MD, Paul R. Julsrud, MD, and Francisco J. Puga, MD Divisions
More informationSurgical Treatment for Double Outlet Right Ventricle. Masakazu Nakao Consultant, Paediatric Cardiothoracic Surgery
for Double Outlet Right Ventricle Masakazu Nakao Consultant, Paediatric Cardiothoracic Surgery 1 History Intraventricular tunnel (Kawashima) First repair of Taussig-Bing anomaly (Kirklin) Taussig-Bing
More informationT who has survived first-stage palliative surgical management
Intermediate Procedures After First-Stage Norwood Operation Facilitate Subsequent Repair Richard A. Jonas, MD Department of Cardiac Surgery, Children s Hospital, Boston, Massachusetts Actuarial analysis
More informationIntermediate Results From the Period of the Congenital Heart Surgeons Transposition Study: 1985 to 1989
Intermediate Results From the Period of the Congenital Heart Surgeons Transposition Study: 1985 to 1989 Kevin Turley, MD, Edward D. Verrier, MD, and Congenital Heart Surgeons Society Database California
More informationCORONARY ANOMALIES. Clinical Significance. Disclosures. Definitions. Learning Objectives. Prevalence. Consultant for M2S, Inc.
Disclosures CORONARY ANOMALIES Consultant for M2S, Inc. Julianna M. Czum, MD Director, Division of Cardiothoracic Imaging Department of Radiology Dartmouth Hitchcock Medical Center Assistant Professor
More informationMultimodality Imaging of Anomalous Left Coronary Artery from the Pulmonary
1 IMAGES IN CARDIOVASCULAR ULTRASOUND 2 3 4 Multimodality Imaging of Anomalous Left Coronary Artery from the Pulmonary Artery 5 6 7 Byung Gyu Kim, MD 1, Sung Woo Cho, MD 1, Dae Hyun Hwang, MD 2 and Jong
More informationLong-Term Outcome of Direct Neopulmonary Artery Reconstruction During the Arterial Switch Procedure
Long-Term Outcome of Direct Neopulmonary Artery Reconstruction During the Arterial Switch Procedure Jacek J. Moll, MD, PhD, Krzysztof W. Michalak, MD, Katarzyna Młudzik, MD, PhD, Tomasz Moszura, MD, PhD,
More informationIn 1980, Bex and associates 1 first introduced the initial
Technique of Aortic Translocation for the Management of Transposition of the Great Arteries with a Ventricular Septal Defect and Pulmonary Stenosis Victor O. Morell, MD, and Peter D. Wearden, MD, PhD In
More informationCARDIOVASCULAR SURGERY
Volume 107, Number 4 April 1994 The Journal of THORACIC AND CARDIOVASCULAR SURGERY Cardiac and Pulmonary Transplantation Risk factors for graft failure associated with pulmonary hypertension after pediatric
More informationIJTCVS Bisoi et al ; 22: 5 9 ASO
IJTCVS Bisoi et al 5 Original article D Transposition of great vessels with intact ventricular septum presenting at 3 8 weeks: Should all go for rapid two stage arterial switch or primary arterial switch?
More informationThe need for right ventricular outflow tract reconstruction
Polytetrafluoroethylene Bicuspid Pulmonary Valve Implantation James A. Quintessenza, MD The need for right ventricular outflow tract reconstruction and pulmonary valve replacement is increasing for many
More informationThe presence of a bicuspid aortic valve is associated
Neoaortic Bicuspid Valve in Arterial Switch Operation: Mid-Term Follow-Up CARDIOVASCULAR Shahid M. Khan, FRCS, Ahmad Bin Sallehuddin, FRCS, Ziad R. Al-Bulbul, MD, and Zohair Y. Al-Halees, MD King Faisal
More informationObstructed total anomalous pulmonary venous connection
Total Anomalous Pulmonary Venous Connection Richard A. Jonas, MD Children s National Medical Center, Department of Cardiovascular Surgery, Washington, DC. Address reprint requests to Richard A. Jonas,
More informationSports cardiology: Pre-competition screening
Sports cardiology: Pre-competition screening Dr. med Andreas E. Brauchlin Division of cardiology, University Hospital, Zurich andreas.brauchlin@usz.ch Content Interactive case presentation Background and
More informationORIGINAL ARTICLE. ANATOMICAL VARIATIONS OF NODAL ARTERIES IN HUMAN HEARTS. Anjali S Sabnis, Nazmeen N Silotry
ANATOMICAL VARIATIONS OF NODAL ARTERIES IN HUMAN HEARTS. Anjali S Sabnis, Nazmeen N Silotry 1. Associate Professor, Department of Anatomy, K. J. Somaiya Medical College, Sion, Mumbai, 2. Associate Professor,
More informationBicuspid aortic root spared during ascending aorta surgery: an update of long-term results
Short Communication Bicuspid aortic root spared during ascending aorta surgery: an update of long-term results Marco Russo, Guglielmo Saitto, Paolo Nardi, Fabio Bertoldo, Carlo Bassano, Antonio Scafuri,
More informationSingle Ventricle with Mitral and Aortic Atresia
1 Bahrain Medical Bulletin, Vol. 26, No. 2, June 2004 Single Ventricle with Mitral and Aortic Atresia Vijaya V Mysorekar, MBBS, MD* Chitralekha P Dandekar, MBBS, MD** Saraswati G Rao, MBBS, MD*** We report
More informationSurgery For Ebstein Anomaly
Surgery For Ebstein Anomaly Christian Pizarro, MD Chief, Pediatric Cardiothoracic Surgery Director, Nemours Cardiac Center Alfred I. dupont Hospital for Children Professor of Surgery and Pediatrics Sidney
More information(Ann Thorac Surg 2008;85:845 53)
I Made Adi Parmana The utility of intraoperative TEE has become increasingly more evident as anesthesiologists, cardiologists, and surgeons continue to appreciate its potential application as an invaluable
More informationCardiac MRI in ACHD What We. ACHD Patients
Cardiac MRI in ACHD What We Have Learned to Apply to ACHD Patients Faris Al Mousily, MBChB, FAAC, FACC Consultant, Pediatric Cardiology, KFSH&RC/Jeddah Adjunct Faculty, Division of Pediatric Cardiology
More informationAn anterior aortoventriculoplasty, known as the Konno-
The Konno-Rastan Procedure for Anterior Aortic Annular Enlargement Mark E. Roeser, MD An anterior aortoventriculoplasty, known as the Konno-Rastan procedure, is a useful tool for the cardiac surgeon. Originally,
More informationSurgical Results of Arterial Switch Operation for Taussig-Bing Anomaly: Is Position of the Great Arteries a Risk Factor?
Surgical Results of Arterial Switch Operation for Taussig-Bing Anomaly: Is Position of the Great Arteries a Risk Factor? Mark D. Rodefeld, MD, Mark Ruzmetov, MD, PhD, Palaniswamy Vijay, PhD, MPH, Andrew
More informationCoronary Artery Anomalies from Birth to Adulthood; the Role of CT Coronary Angiography in Sudden Cardiac Death Screening
Coronary Artery Anomalies from Birth to Adulthood; the Role of CT Coronary Angiography in Sudden Cardiac Death Screening E O Dwyer 1, C O Brien 1, B Loo 1, A Snow Hogan 1, O Buckley1 2, B 1. Department
More informationTwenty-five years ago Jatene and colleagues1 first described the. Twenty-five years experience with the arterial switch operation
Surgery for Congenital Heart Disease Twenty-five years experience with the arterial switch operation P. A. Hutter, MD D. L. Kreb, MD S. F. Mantel, MD J. F. Hitchcock, MD, PhD E. J. Meijboom, MD, PhD, FACC
More informationCoronary Anomalies & Hemodynamic Identification
Coronary Anomalies & Hemodynamic Identification David Stultz, MD Cardiology Fellow, PGY 6 May 2, 2006 Anomaly #1 Anomaly #2 Anomaly #3 Figure 18-27 Anomalous origin of the left circumflex artery.
More informationRepair of Complete Atrioventricular Septal Defects Single Patch Technique
Repair of Complete Atrioventricular Septal Defects Single Patch Technique Fred A. Crawford, Jr., MD The first repair of a complete atrioventricular septal defect was performed in 1954 by Lillehei using
More informationCase Report Preoperative Assessment of Anomalous Right Coronary Artery Arising from the Main Pulmonary Artery
Case Reports in Medicine Volume 2011, Article ID 642126, 4 pages doi:10.1155/2011/642126 Case Report Preoperative Assessment of Anomalous Right Coronary Artery Arising from the Main Pulmonary Artery Marshall
More informationUtility of CT angiography for pre-operative evaluation of robotic-assisted minimally invasive mitral valve surgery.
Utility of CT angiography for pre-operative evaluation of robotic-assisted minimally invasive mitral valve surgery. Poster No.: C-2214 Congress: ECR 2014 Type: Educational Exhibit Authors: M. Muthuvelu,
More informationCase 47 Clinical Presentation
93 Case 47 C Clinical Presentation 45-year-old man presents with chest pain and new onset of a murmur. Echocardiography shows severe aortic insufficiency. 94 RadCases Cardiac Imaging Imaging Findings C
More informationDouble outlet right ventricle: navigation of surgeon to chose best treatment strategy
Double outlet right ventricle: navigation of surgeon to chose best treatment strategy Jan Marek Great Ormond Street Hospital & Institute of Cardiovascular Sciences, University College London Double outlet
More informationIntroduction. Study Design. Background. Operative Procedure-I
Risk Factors for Mortality After the Norwood Procedure Using Right Ventricle to Pulmonary Artery Shunt Ann Thorac Surg 2009;87:178 86 86 Addressor: R1 胡祐寧 2009/3/4 AM7:30 SICU 討論室 Introduction Hypoplastic
More informationEarly and mid-term follow-up of patients receiving arterial switch operation: a single-center experience
Original Article Early and mid-term follow-up of patients receiving arterial switch operation: a single-center experience Yaqiong Xiao*, Ping Zhang*, Wei Su, Nianguo Dong Department of Cardiovascular Surgery,
More informationSurgical Treatment of Aortic Arch Hypoplasia
Surgical Treatment of Aortic Arch Hypoplasia In the early 1990s, 25% of patients could face mortality related to complica-tions of hypertensive disease Early operations and better surgical techniques should
More informationA Two-Year Experience with Supported
THE ANNALS OF THORACIC SURGERY Journal of The Society of Thoracic Surgeons and the Southern Thoracic Surgical Association VOLUME 13 * NUMBER 2 - FEBRUARY 19 72 A Two-Year Experience with Supported Autologous
More informationCV Anatomy Quiz. Dr Ella Kim Dr Pip Green
CV Anatomy Quiz Dr Ella Kim Dr Pip Green Q1 The location of the heart is correctly described as A) lateral to the lungs. B) medial to the sternum. C) superior to the diaphragm. D) posterior to the spinal
More informationAortic root false aneurysm from gelatin-resorcinolformaldehyde GRF glue following surgical treatment for type A dissection
Jichi Medical University Journal Aortic root false aneurysm from gelatin-resorcinolformaldehyde GRF glue following surgical treatment for type A dissection Yasuhito Sakano, Tsutomu Saito, Yoshio Misawa
More informationBIVENTRICULAR REPAIR FOR AORTIC ATRESIA OR HYPOPLASIA AND VENTRICULAR SEPTAL DEFECT
BIVENTRICULAR REPAIR FOR AORTIC ATRESIA OR HYPOPLASIA AND VENTRICULAR SEPTAL DEFECT Richard G. Ohye, MD a Koji Kagisaki, MD a Lisa A. Lee, MD b Ralph S. Mosca, MD a Caren S. Goldberg, MD b Edward L. Bove,
More informationCASE REPORT Anomalies Associated With Congenitally Corrected Transposition of Great Arteries: Expect the Unexpected
CASE REPORT Anomalies Associated With Congenitally Corrected Transposition of Great Arteries: Expect the Unexpected Valay Parikh, MD, a Masood A. Shariff, MD, b Faisal B. Saiful, MD, c Syed Bilal Rizvi,
More informationPulmonary Valve Replacement
Pulmonary Valve Replacement with Fascia Lata J. C. R. Lincoln, F.R.C.S., M. Geens, M.D., M. Schottenfeld, M.D., and D. N. Ross, F.R.C.S. ABSTRACT The purpose of this paper is to describe a technique of
More informationSURGICAL INTERVENTION IN AORTOPATHIES ZOHAIR ALHALEES, MD RIYADH, SAUDI ARABIA
SURGICAL INTERVENTION IN AORTOPATHIES ZOHAIR ALHALEES, MD RIYADH, SAUDI ARABIA In patients born with CHD, dilatation of the aorta is a frequent feature at presentation and during follow up after surgical
More informationAdult Congenital Heart Disease: What All Echocardiographers Should Know Sharon L. Roble, MD, FACC Echo Hawaii 2016
1 Adult Congenital Heart Disease: What All Echocardiographers Should Know Sharon L. Roble, MD, FACC Echo Hawaii 2016 DISCLOSURES I have no disclosures relevant to today s talk 2 Why should all echocardiographers
More informationHow to Perform a Valve Sparing Root Replacement Joseph S. Coselli, M.D.
How to Perform a Valve Sparing Root Replacement Joseph S. Coselli, M.D. AATS International Cardiovascular Symposium 2017 Session 6: Technical Aspects of Open Surgery on the Aortic Valve Sao Paulo, Brazil
More informationComplex Congenital Heart Disease in Adults
Complex Congenital Heart Disease in Adults Linda B. Haramati, MD Disclosures Complex Congenital Heart Disease in Adults Linda B. Haramati MD, MS Jeffrey M. Levsky MD, PhD Meir Scheinfeld MD, PhD Department
More informationAnatomy determines the close vicinity of the sinuses of
Aortic Valve Reimplantation According to the David Type I Technique Matthias Karck, MD, and Axel Haverich, MD Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
More informationM/3, cc-tga, PS, BCPC(+) Double Switch Operation
2005 < Pros & Cons > M/3, cc-tga, PS, BCPC(+) Double Switch Operation Congenitally corrected TGA Atrio-Ventricular & Ventriculo-Arterial discordance Physiologically corrected circulation with the morphologic
More informationTechniques for repair of complete atrioventricular septal
No Ventricular Septal Defect Patch Atrioventricular Septal Defect Repair Carl L. Backer, MD *, Osama Eltayeb, MD *, Michael C. Mongé, MD *, and John M. Costello, MD For the past 10 years, our center has
More informationSurgical Procedures and Complications
Radiological Society of North America, RSNA 2013 Refresher Course Program: Vascular Track Surgical Procedures and Complications Learning objectives Outline RC 112 : Key Concepts: Surgical Procedures and
More informationBudi Yuli Setianto, Anggoro Budi Hartopo, Putrika Prastuti Ratna Gharini, and Nahar Taufiq. 1. Introduction. 2. Case Report
Case Reports in Cardiology Volume 2016, Article ID 7652869, 4 pages http://dx.doi.org/10.1155/2016/7652869 Case Report Anomalous Origination of Right Coronary Artery from Left Sinus in Asymptomatic Young
More informationUltrasound. Computed tomography. Case studies. Utility of IQon Spectral CT in. cardiac imaging
Ultrasound Computed tomography Case studies Utility of IQon Spectral CT in cardiac imaging Cardiac imaging is a challenging procedure where it is necessary to image a motion-free heart. This requires a
More informationRight Coronary Artery With Anomalous Origin and Slit Ostium
Right Coronary Artery With Anomalous Origin and Slit Ostium Raul Garcia Rinaldi, MO, Jorge Carballido, MO, Richard Giles, MO, Emilio Del Taro, MO, and Raul Porro, MO Departments of Cardiovascular Surgery
More informationA New Radiopaque Surgical Suture* Juro WADA, M.D. and Masahiro ENDO, M.D.
A New Radiopaque Surgical Suture* Juro WADA, M.D. and Masahiro ENDO, M.D. SUMMARY We have developed a new X-ray visible suture. It is a polyester suture containing platinum wires. The radiopaque suture
More informationJournal of Radiology Research and Practice
Journal of Radiology Research and Practice Vol. 2015 (2015), Article ID 312482, 25 minipages. DOI:10.5171/2015.312482 www.ibimapublishing.com Copyright 2015. Jonszta Tomas, Pleva Leos, Krivankova Katerina
More informationCongenital Coronary Anomalies
Chapter 50 Congenital Coronary Anomalies S. Adil Husain, Brett C. Sheridan, and Michael R. Mill Congenital coronary anomalies may have a significant impact on myocardial perfusion and secondary ischemia,
More informationWhat Can the Database Tell Us About Reoperation?
AATS/STS Congenital Heart Disease Postgraduate Symposium May 5, 2013 What Can the Database Tell Us About Reoperation? Jeffrey P. Jacobs, M.D. All Children s Hospital Johns Hopkins Medicine The Congenital
More informationImaging in TAVI. Jeroen J Bax Dept of Cardiology Leiden Univ Medical Center The Netherlands Davos, feb 2013
Imaging in TAVI Jeroen J Bax Dept of Cardiology Leiden Univ Medical Center The Netherlands Davos, feb 2013 Research grants: Medtronic, Biotronik, Boston Scientific, St Jude, BMS imaging, GE Healthcare,
More informationS. Bruce Greenberg, MD FNASCI and President, NASCI Professor of Radiology and Pediatrics University of Arkansas for Medical Sciences
S. Bruce Greenberg, MD FNASCI and President, NASCI Professor of Radiology and Pediatrics University of Arkansas for Medical Sciences No financial disclosures Aorta Congenital aortic stenosis/insufficiency
More informationABNORMAL ORIGIN OF THE LEFT CIRCUMFLEX CORONARY ARTERY FROM THE RIGHT CORONARY ARTERY
ABNORMAL ORIGIN OF THE LEFT CIRCUMFLEX CORONARY ARTERY FROM THE RIGHT CORONARY ARTERY Antonio Fuertes, M.D.,* Mario Trivellato, M.D.,** and Jeff Z. Brooker, M.D.*** INTRODUCTION Primary anomalies of the
More informationAlthough most patients with Ebstein s anomaly live
Management of Neonatal Ebstein s Anomaly Christopher J. Knott-Craig, MD, FACS Although most patients with Ebstein s anomaly live through infancy, those who present clinically as neonates are a distinct
More informationTetralogy of Fallot (TOF) with atrioventricular (AV)
Tetralogy of Fallot with Atrioventricular Canal Defect: Two Patch Repair Sitaram M. Emani, MD, and Pedro J. del Nido, MD Tetralogy of Fallot (TOF) with atrioventricular (AV) canal defect is classified
More informationPulmonary Valve Morphology in Patients with Bicuspid Aortic Valves
https://doi.org/10.1007/s00246-018-1807-x ORIGINAL ARTICLE Pulmonary Valve Morphology in Patients with Bicuspid Aortic Valves Wilke M. C. Koenraadt 1 Margot M. Bartelings 2 Adriana C. Gittenberger de Groot
More informationThe outlook for patients with hypoplastic left heart syndrome (HLHS) Tricuspid valve repair in hypoplastic left heart syndrome CHD
Ohye et al Surgery for Congenital Heart Disease Tricuspid valve repair in hypoplastic left heart syndrome Richard G. Ohye, MD a Carlen A. Gomez, MD b Caren S. Goldberg, MD, MS b Holly L. Graves, BA a Eric
More informationTransvenous Pacemaker Implantation 22 years after the Mustard Procedure
Case Report Transvenous Pacemaker Implantation 22 years after the Mustard Procedure Masato Sakamoto MD, Yoshie Ochiai MD, Yutaka Imoto MD, Akira Sese MD, Mamie Watanabe MD, Kunitaka Joo MD Department of
More informationTransposition of the Great Arteries
SMGr up Transposition of the Great Arteries Hala Mounir Agha 1 *, Mohamed Moustafa 2 and Ibrahim Abou Farag 2 1 Pediatric Cardiology Division, Cairo University Specialized Pediatric Hospital, Egypt 2 Pediatric
More informationXLI Cong re s s o Nazionale de lla Socie tà Italiana di Cardiolog ia Pe diatrica Bari, Ottobre
European Journal of Cardio-t horacic Surgery 38 (2010) 714 720 www. el sevier. com/ locat e/ ej ct s E. ANGELI, MD TGA population 137 arterial switch operations (ASO) 1991-2007 Pathology pts IAAo TGA simple
More informationThe Edge-to-Edge Technique f For Barlow's Disease
The Edge-to-Edge Technique f For Barlow's Disease Ottavio Alfieri, Michele De Bonis, Elisabetta Lapenna, Francesco Maisano, Lucia Torracca, Giovanni La Canna. Department of Cardiac Surgery, San Raffaele
More information가천의대길병원소아심장과최덕영 PA C IVS THE EVALUATION AND PRINCIPLES OF TREATMENT STRATEGY
가천의대길병원소아심장과최덕영 PA C IVS THE EVALUATION AND PRINCIPLES OF TREATMENT STRATEGY PA c IVS (not only pulmonary valve disease) Edwards JE. Pathologic Alteration of the right heart. In: Konstam MA, Isner M, eds.
More informationSurgical Results in Patients With Double Outlet Right Ventricle: A 20-Year Experience
Surgical Results in Patients With Double Outlet Right Ventricle: A 20-Year Experience John W. Brown, MD, Mark Ruzmetov, MD, Yuji Okada, MD, Palaniswamy Vijay, PhD, MPH, and Mark W. Turrentine, MD Section
More informationCase. 15-year-old boy with bicuspid AV Severe AR with moderate AS. Ross vs. AVR (or AVP)
Case 15-year-old boy with bicuspid AV Severe AR with moderate AS Ross vs. AVR (or AVP) AMC case 14-year-old boy with bicuspid AV Severe AS with mild AR Body size Bwt: 55 kg, Ht: 154 cm, BSA: 1.53 m 2 Echocardiography
More informationAtrial fibrillation (AF) is associated with increased morbidity
Ablation of Atrial Fibrillation with Concomitant Surgery Edward G. Soltesz, MD, MPH, and A. Marc Gillinov, MD Atrial fibrillation (AF) is associated with increased morbidity and mortality in coronary artery
More informationINTRODUCTION CASE REPORT
Yonsei Med J 50(1):164-168, 2009 DOI 10.3349/ymj.2009.50.1.164 A Case of Acute Myocardial Infarction with the Anomalous Origin of the Right Coronary Artery from the Ascending Aorta above the Left Sinus
More informationA Rare Type of Single Coronary Artery with Right Coronary Artery Originating From. the Left Circumflex Artery in a Child
A Rare Type of Single Coronary Artery with Right Coronary Artery Originating From the Left Circumflex Artery in a Child Jong Min Kim, MD 1, Ok Jeong Lee, MD 1, I-Seok Kang, MD 1, June Huh, MD, PhD 1, Jinyoung
More informationcardiac imaging planes planning basic cardiac & aortic views for MR
cardiac imaging planes planning basic cardiac & aortic views for MR Dianna M. E. Bardo, M. D. Assistant Professor of Radiology & Cardiovascular Medicine Director of Cardiac Imaging cardiac imaging planes
More informationSpecific morphological characteristics of the coronary arteries
ARS Medica Tomitana - 2013; 2(73): 112-116 DOI: 10.2478/arsm-2013-0020 Ispas V., Iliescu D.M, Baz R., Bordei P. Specific morphological characteristics of the coronary arteries Discipline of anatomy, Department
More informationCase # 1. Page: 8. DUKE: Adams
Case # 1 Page: 8 1. The cardiac output in this patient is reduced because of: O a) tamponade physiology O b) restrictive physiology O c) coronary artery disease O d) left bundle branch block Page: 8 1.
More informationCase Report Anomalous Left Main Coronary Artery: Case Series of Different Courses and Literature Review
Case Reports in Vascular Medicine Volume 2013, Article ID 380952, 5 pages http://dx.doi.org/10.1155/2013/380952 Case Report Anomalous Left Main Coronary Artery: Case Series of Different Courses and Literature
More information