No abstract

The arterial switch operation (ASO) has evolved into the treatment of the choice for most forms of transposition of the great arteries (TGA). Despite advancement in the technical aspects of the procedure, certain anatomical variations of the coronary arteries are still considered as surgical risks. We have recently employed a novel technique for coronary artery reconstruction in ASO to achieve further improvement of coronary transfer in cases with complex coronary anatomy. The technical key of the procedure is that reconstruction of the coronary arteries is preceded by neo-aortic anastomosis. After neo-aortic reconstruction is accomplished, the neo-aorta is temporarily distended with removal of the cross-clamp. The distended neo-aorta informs us its postsurgical geometry, which facilitates accurate assessment for the optimal site of coronary button transfer.

In Japan, no pulsatile ventricular assist devices are available specifically for use in children. Pumps designed for adults are thus often used in children. We report herein a case of end-stage heart failure in a 3-year old girl (height 100.4 cm; body weight 16.2 kg; body surface area 0.66 m2) who underwent implantation with an adult-sized Toyobo-NCVC left ventricular assist device (Toyobo-National Cardiovascular Center, Osaka, Japan) in our unit. We started with the driving mode to "full-fill, full-empty" mode. The problem was difficult-to-treat hypertension due to excessive stroke volume induced by the left ventricular assist device. Aggressive administration of antihypertensive therapy was needed. Successful heart transplantation was performed in Germany 5 months after beginning support with the Toyobo-NCVC left ventricular assist device.