Half-turned Truncal Switch Operation for Transposition of Great Arteries, Ventricular Septal Defect and Pulmonic Stenosis

폐동맥 협착과 심실 중격 결손을 동반한 대혈관 전위에서 시행한 반회전 동맥간 전환술

  • Lim Hong Gook (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Hwang Seong Wook (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Lee Cheul (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Kim Chong Whan (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute) ;
  • Kim Jun Seok (Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University) ;
  • Lee Chang-Ha (Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute)
  • 임홍국 (부천세종병원 흉부외과, 세종심장연구소) ;
  • 황성욱 (부천세종병원 흉부외과, 세종심장연구소) ;
  • 이철 (부천세종병원 흉부외과, 세종심장연구소) ;
  • 김종환 (부천세종병원 흉부외과, 세종심장연구소) ;
  • 김준석 (건국대학교병원 흉부외과) ;
  • 이창하 (부천세종병원 흉부외과, 세종심장연구소)
  • Published : 2006.02.01

Abstract

The surgical management of patients with transposition of the great arteries, ventricular septal defect, and pulmonary stenosis remains a challenge. The Rastelli operation or Lecompte operation is the preferred surgical procedure, but its long-term results are not optimal because of a warped left ventricular outflow tract through a space-occupied intraventricular tunnel and a contrived right ventricular outflow tract. We performed a half-turned truncal switch operation as an alternative surgical procedure in a 3-year-old boy (weighing 9.6 kg) with this anomaly. Postoperative echocardiography showed laminar flow through straight and nonobstructive aortic and pulmonary ventricular outflow tracts.

폐동맥 협착과 심실 중격 결손을 동반한 대혈관 전위를 갖는 환자들에 대한 수술은 Rastelli 수술법이나 Lecornpte 수술법이 전통적으로 시행되어 왔으나, 심실 내 터널에 의한 뒤틀린 좌심실 유출로와 부자연스러운 우심실 유출로에 의해 장기 성적은 만족스럽지 않다. 이에 대한 대안으로 저자들은 이 기형으로 진단된 3세 환아(체중 9.6 kg)에서 반회전 동맥간 전환술(half-turned truncal switch operation)을 시행하였다. 술 후 심초음파 검사에서 좌심실유출로와 우심실유출로가 곧고 넓게 형성되어 향후 좋은 장기 결과가 기대된다.

Keywords

References

  1. Kreutzer C, De Vive J, Oppido G, et al. Twenty-five-year experience with Rastelli repair for transposition of the great arteries. J Thorac Cardiovasc Surg 2000;120:211-23 https://doi.org/10.1067/mtc.2000.108163
  2. Dearani JA, Danielson GK, Puga FJ, et al. Late results of the Rastelli operation for transposition of the great arteries. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2001;4:3-15 https://doi.org/10.1053/tc.2001.24649
  3. Vouhe' PR, Tamisier D, Leca F, Ouaknine R, Vernant F, Neveux JY. Transposition of the great arteries, ventricular septal defect, and pulmonary outflow tract obstruction: Rastelli or Lecompte procedure? J Thorac Cardiovasc Surg 1992;103:428-36
  4. Rychik J, Jacobs ML, Norwood WI. Early changes in ventricular geometry and ventricular septal defect size following Rastelli operation or intraventricular baffle repair for conotruncal anomaly: a cause for development of subaortic stenosis. Circulation 1994;90(Suppl):II-13-9
  5. Graham TP, Franklin RC, Wyse RK, Gooch V, Deanfield JE. Left ventricular wall stress and contractile function in transposition of the great arteries after the Rastelli operation. J Thorac Cardiovasc Surg 1987;93:775-84
  6. Palik I, Graham TP, Burger J. Ventricular pump performance in patients with obstructed right ventricular-pulmonary artery conduits. Am Heart J 1986;112:1271-8 https://doi.org/10.1016/0002-8703(86)90359-5
  7. Nikaidoh H. Aortic translocation and biventricular outflow tract reconstruction: a new surgical repair for transposition of the great arteries associated with ventricular septal defect and pulmonary stenosis. J Thorac Cardiovasc Surg 1984;88:365-72
  8. Yamagishi M, Shuntoh K, Matsushita T, et al. Half-turned truncal switch operation for complete transposition of the great arteries with ventricular septal defect and pulmonary stenosis. J Thorac Cardiovasc Surg 2003;125:966-8 https://doi.org/10.1067/mtc.2003.33