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DOI: 10.1055/s-2007-965740
© Georg Thieme Verlag KG Stuttgart · New York
Neonatal Kawashima Intraventricular Repair for Taussig-Bing Anomaly with Oblique Relationship of the Great Arteries
Publication History
Received June 3, 2007
Publication Date:
14 November 2008 (online)
Introduction
Taussig-Bing anomaly is one of a complex group of lesions involving various relationships of the great arteries and the coronary artery anatomy. There are two main options for definitive repair: intraventricular repair (IVR) as described by Kawashima [1] and the arterial switch operation (ASO) introduced by Yacoub [2]. Although the choice of procedure was controversially discussed in the 1990s [3], [4], [5], ASO has become the procedure of choice in the last decade because of its feasibility [6], [7], [8], [9], [10], [11]. However, most recent reports have noted some degree of early mortality mainly due to coronary mal-perfusion [10] and late right ventricular outflow tract obstruction (RVOTO) [12] after the ASO. Although IVR has its limitations with respect to the relationship of the great arteries, it has the advantage of avoiding coronary artery relocation and preserving the native aortic valve. Here, we present a case of Taussig-Bing anomaly, which was successfully corrected by IVR in the neonatal period.
Clinical summary
A newborn with a suspected cardiac anomaly by fetal echocardiography was transferred to our unit soon after birth. Echocardiography showed subpulmonary VSD and both great arteries arising from the right ventricle with an oblique relationship, a restrictive foramen ovale, and a hypoplastic distal aortic arch. Balloon atrioseptostomy and stent implantation in the distal aortic arch were performed the day after admission. Subsequently, the baby underwent primary surgical repair in the 4th week of age.
After a median sternotomy, initiation of cardiopulmonary bypass and cardioplegic arrest, the right ventricle was opened longitudinally. There was a large subpulmonary VSD in the middle portion of the septum. The aortic valve was located right anteriorly with a developed infundibular septum. The distance from the tricuspid ring to the pulmonary valve ring (T‐P distance) was 3 mm ([Fig. 1 A, D]). After extensive resection of the infundibular septum, interrupted mattress sutures were placed from the VSD to the aortic route ([Fig. 1 B, E]). Left ventricular outflow tract (LVOT) reconstruction was done with a Dacron prosthesis (Hemashield: 10 mm; Boston Scientific, MA, USA) cut in an oval shape ([Fig. 1 C, F]). The right ventricular outflow tract was reconstructed with a pericardial patch. The neonate had an uneventful postoperative course and echocardiography 3 months postoperatively showed no evidence of significant LVOT obstruction ([Fig. 2]).
Fig. 1 A to F Intraoperative drawings and pictures through a right ventriculotomy from the surgeon's point of view. The VSD was located adjacent to the pulmonary valves and the distance between the tricuspid valve and pulmonary valve (✶) was 3 mm (A, D). After extensive resection of the infundibular septum, interrupted mattress sutures were secured (B, E), and a Dacron prosthesis was placed from the VSD to the aortic route (C, F). VSD: ventricular septal defect; TV: tricuspid valve; PV: pulmonary valve. Fig. 2 Postoperative echocardiography. There is no significant stenosis in the LVOT. LV: left ventricle; LVOT: left ventricular outflow tract.