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1 Complete Transposition of the Great Arteries  1

◙◙ Introduction  2
◙◙ Anatomy  3
◙◙ Complete Transposition of the Great Arteries,
with or without Ventricular Septal Defect   5
◙◙ Indication for Surgery  5
◙◙ Approach and Cardiopulmonary Bypass Strategy  5
◙◙ Arterial Switch Operation   6
◙◙ The Goal of Surgery  6
◙◙ Arterial Switch Operation in Simple Transposition with
a Coronary Pattern (1AD; 2R, Cx)  6
◙◙ Patient Characteristics   6
◙◙ Specific Steps of Operation   7
◙◙ Arterial Switch Operation in Situs Inversus
with a Coronary Pattern (1R; 2AD, Cx)  13
◙◙ Patient Characteristics   13
◙◙ Specific Steps of Operation   14
◙◙ Arterial Switch Operation with a Coronary Pattern (1R; AD, Cx)   20
◙◙ Patient Characteristics   20
◙◙ Specific Steps of Operation   21
◙◙ Arterial Switch Operation with a Coronary Pattern (2R; AD, Cx)   24
◙◙ Patient Characteristics   24
◙◙ Specific Steps of Operation   24
◙◙ Arterial Switch Operation in Complex Transposition with Crisscross Heart,
Multiple Ventricular Septal Defects, Straddling of Tricuspid Valve, Mild Subvalvar
and Valvar Pulmonary Stenosis, and with a Coronary Pattern (1Cx; 2R, AD)  26
◙◙ Patient Characteristics   26
◙◙ Specific Steps of Operation   27
◙◙ Complete Transposition of the Great Arteries with Ventricular Septal
Defect and Left Ventricular Outflow Tract Obstruction   35
◙◙ Indication for Surgery  35
◙◙ Approach and Cardiopulmonary Bypass Strategy  35
◙◙ REV (Réparation à l’étage ventriculaire) Operation 36
◙◙ The Goal of Surgery  36
◙◙ Patient Characteristics  37
◙◙ Specific Steps of Operation   37

V. Hraška, P. Murín, Surgical Management of Congenital Heart Disease I, XI

DOI:10.1007/978-3-642-24169-7, © Springer-Verlag Berlin Heidelberg 2012
XII V. Hraška, P. Murín

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◙◙ Bex–Nikaidoh Procedure  43
◙◙ The Goal of Surgery  43
◙◙ Patient Characteristics   44
◙◙ Specific Steps of Operation   44
◙◙ Recommended Reading  51

2 Corrected Transposition of the Great Arteries  53

◙◙ Introduction  54
◙◙ Anatomy  55
◙◙ Ventricular Septal Defect  57
◙◙ Conduction System  57
◙◙ Coronaries  58
◙◙ Anatomical Correction of Corrected Transposition of the Great Arteries   59
◙◙ Indication for Anatomical Correction  59
◙◙ Approach and Cardiopulmonary Bypass Strategy   60
◙◙ Modified Senning Operation   61
◙◙ The Goal of Surgery  61
◙◙ Modified Half-Mustard Operation   62
◙◙ The Goal of Surgery   62
◙◙ Arterial Switch Operation for Corrected Transposition of the Great Arteries  62
◙◙ The Goal of Surgery  62
◙◙ Rastelli Operation for Corrected Transposition of the Great Arteries  62
◙◙ The Goal of Surgery  62
◙◙ Bex–Nikaidoh Procedure for Corrected Transposition of the Great Arteries  63
◙◙ The Goal of Surgery  63
◙◙ Double Switch Operation for Corrected Transposition of the Great Arteries {SLL},
with Resection of the Subpulmonary Obstruction in Situs Solitus and Levocardia  64
◙◙ Patient Characteristics   64
◙◙ Specific Steps of Operation  64
◙◙ Closure of the Ventricular Septal Defect During the Double Switch Procedure   73
◙◙ Senning–Rastelli Operation for Corrected Transposition of the Great Arteries {SLL}
with Ventricular Septal Defect, Pulmonary Atresia, and Dextrocardia   74
◙◙ Patient Characteristics   74
◙◙ Specific Steps of Operation   74
◙◙ Senning–Rastelli Operation for Corrected Transposition of the Great
Arteries {IDD} with Noncommitted Ventricular Septal Defect,
Pulmonary Stenosis, Situs Inversus, and Levocardia   79
◙◙ Patient Characteristics   79
◙◙ Specific Steps of Operation   79
◙◙ Modified Half-Mustard and Rastelli Operation for Corrected Transposition
of the Great Arteries {SLL} in Situs Solitus with Dextrocardia   85
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◙◙ Patient Characteristics   85
◙◙ Specific Steps of Operation   85
◙◙ Modified Senning and Bex–Nikaidoh Procedure for Corrected
Transposition of the Great Arteries {IDD} with an Inlet Ventricular
Septal Defect in Situs Inversus and Mesocardia  87
◙◙ Patient Characteristics   87
◙◙ Specific Steps of Operation   88
◙◙ Recommended Reading  92

3 Left Ventricular Outflow Tract Anomalies  93

◙◙ Introduction  95
◙◙ Aortic Stenosis in Neonates and Infants  95
◙◙ Anatomy 95
◙◙ Indication for Surgery  96
◙◙ Approach and Cardiopulmonary Bypass Strategy  96
◙◙ Open Valvotomy for Critical Aortic Stenosis in the Newborn  97
◙◙ The Goal of Surgery  97
◙◙ Patient Characteristics  97
◙◙ Specific Steps of Surgery   97
◙◙ Aortic Stenosis in Children  101
◙◙ Anatomy 101
◙◙ Indication for Surgery  101
◙◙ Approach and Cardiopulmonary Bypass Strategy  101
◙◙ The Goal of Surgery  102
◙◙ Aortic Insufficiency in Children  102
◙◙ Anatomy 102
◙◙ Indication for Surgery  103
◙◙ Approach and Cardiopulmonary Bypass Strategy  103
◙◙ The Goal of Surgery  104
◙◙ Subcommissural Downsizing of the Aortic Annulus,
with Asymmetric Resection of the Sinus Valsalva  107
◙◙ Patient Characteristics  107
◙◙ Specific Steps of Surgery  107
◙◙ Resection of the Subaortic Membrane and Pericardial
Patch Augmentation of the Aortic Valve  109
◙◙ Patient Characteristics  109
◙◙ Specific Steps of Surgery   109
◙◙ Aortic Valve Reconstruction with Pericardial Extensions, Resection of the
Subaortic Membrane, and Closure of the Aneurysm of the Sinus Valsalva  111
◙◙ Patient Characteristics  111
◙◙ Specific Steps of Surgery   112
XIV V. Hraška, P. Murín

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◙◙ Tricuspidalization of the Unicuspid Aortic Valve – Reconstruction
of Two Cusps with the Native Tissue and Creation of the
Remaining Cusp Using Autologous Pericardium  115
◙◙ Patient Characteristics  115
◙◙ Specific Steps of Surgery   115
◙◙ Reconstruction of an Aortic Valve Destroyed by Bacterial
Endocarditis – Closure of an Abscess Formation Invading the Annulus
of the Aortic Valve and Anterior Leaflet of the Mitral Valve  118
◙◙ Patient Characteristics  118
◙◙ Specific Steps of Surgery   119
◙◙ Ross Operation  120
◙◙ The Goal of Surgery   120
◙◙ Patient Characteristics  120
◙◙ Specific Steps of Surgery   120
◙◙ Subvalvar Aortic Stenosis  127
◙◙ Introduction 127
◙◙ Anatomy  127
◙◙ Indication for Surgery  128
◙◙ Approach and Cardiopulmonary Bypass Strategy  129
◙◙ Resection of a Discrete Subaortic Membrane  129
◙◙ The Goal of Surgery  129
◙◙ Patient Characteristics   129
◙◙ Specific Steps of Surgery   130
◙◙ Ross–Konno Operation with Resection of Endocardial
Fibroelastosis in the Infant  132
◙◙ The Goal of Surgery  132
◙◙ Patient Characteristics  133
◙◙ Specific Steps of Surgery   134
◙◙ Supravalvar Aortic Stenosis  141
◙◙ Introduction 141
◙◙ Anatomy  141
◙◙ Indication for Surgery  142
◙◙ Approach and Cardiopulmonary Bypass Strategy  142
◙◙ Symmetric Three-Patch Technique with Central Pulmonary Artery Plasty  142
◙◙ The Goal of Surgery   142
◙◙ Patient Characteristics  143
◙◙ Specific Steps of Surgery   143
◙◙ Symmetric Nonpatch Technique (Myer’s)  148
◙◙ The Goal of Surgery   148
◙◙ Patient Characteristics  148
◙◙ Specific Steps of Surgery   148
◙◙ Recommended Reading  149
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4 Tetralogy of Fallot  151

◙◙ Introduction  152
◙◙ Tetralogy of Fallot with Pulmonary Stenosis  153
◙◙ Anatomy  153
◙◙ Indication for Surgery  154
◙◙ Approach and Cardiopulmonary Bypass Strategy  154
◙◙ Transatrial Approach with Release of the Right
Ventricular Outflow Tract Obstruction   154
◙◙ The Goal of Surgery  154
◙◙ Patient Characteristics   155
◙◙ Specific Steps of Operation   155
◙◙ Transatrial Approach with Resection of the Right Ventricular
Outflow Tract and Valvotomy of the Pulmonary Valve  159
◙◙ The Goal of Surgery  159
◙◙ Patient Characteristics   159
◙◙ Specific Steps of Operation   159
◙◙ Transatrial Approach with a Mini-Transannular Patch  160
◙◙ The Goal of Surgery  160
◙◙ Patient Characteristics  160
◙◙ Specific Steps of Operation   161
◙◙ Tetralogy of Fallot with Pulmonary Atresia and Ductus-
Dependent Pulmonary Circulation  164
◙◙ Anatomy  164
◙◙ Indication for Surgery  164
◙◙ Transventricular Approach Preserving the Natural Connection of the Right Ventricle
and Pulmonary Artery with Patch Enlargement of the Outflow Tract  164
◙◙ The Goal of Surgery  164
◙◙ Patient Characteristics  165
◙◙ Specific Steps of Operation   165
◙◙ Direct Connection of the Pulmonary Artery and Right Ventriculotomy
with Patch Enlargement of the Outflow Tract  168
◙◙ The Goal of Surgery  168
◙◙ Patient Characteristics  168
◙◙ Specific Steps of Operation   169
◙◙ Tetralogy of Fallot with Absent Pulmonary Valve Syndrome  173
◙◙ Anatomy  173
◙◙ Indication for Surgery  173
◙◙ Technique of Anterior Translocation of the Pulmonary Artery  173
◙◙ The Goal of Surgery  173
◙◙ Patient Characteristics  174
◙◙ Specific Steps of Operation   174
◙◙ Recommended Reading  181
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5 Ebstein’s Anomaly  183

◙◙ Introduction 184
◙◙ Anatomy 184
◙◙ Indication for Surgery  185
◙◙ Newborns and Young Infants  185
◙◙ Older Patients  185
◙◙ Approach and Cardiopulmonary Bypass Strategy  186
◙◙ Anatomical Repair – Cone Reconstruction   186
◙◙ The Goal of Surgery  186
◙◙ Cone Reconstruction with Longitudinal Plication
of the Atrialized Ventricle in the Newborn  188
◙◙ Patient Characteristics  188
◙◙ Specific Steps of Operation   188
◙◙ Cone Reconstruction with Longitudinal Plication
of the Atrialized Ventricle in the Infant  194
◙◙ Patient Characteristics  194
◙◙ Specific Steps of Operation  194
◙◙ Cone Reconstruction without Plication of the Atrialized Ventricle   196
◙◙ Patient Characteristics  196
◙◙ Specific Steps of Operation   196
◙◙ Recommended Reading  201