Ductal Stenting to Retrain the Involuted Left Ventricle in d-Transposition of the Great Arteries

Use of a composite survival curve to optimise the surgical strategy for repair of transposition of the great arteries

“…Morphological parameters such as ventricular wall thickness, ventricular muscle mass and the "position" of the interventricular septum have been proposed as predictors of a successful "low risk" ASO (Lacour-Gayet et al, 2001). A period of left ventricular retraining (LVR), either by banding the main pulmonary artery or stenting a patent ductus arteriosus (PDA) have also been advocated as a means of increasing the likelihood that the left ventricle will support the systemic circulation after the ASO (Raissadati et al, 2017;Leong et al, 2019). Postoperative mechanical support of the left ventricle has also been proposed as method of increasing the chance that the left ventricle will tolerate an ASO (Malankar et al, 2020).…”

Ductal Stenting and Judicious Avoidance of Septostomy Rapidly Retrain a Regressed Left Ventricle in D Transposition: A Case Report

“…Furthermore so since increasing the ASD/IAS ratio (0.18) might hinder successful LV retraining. 2) 3) …”

“…Echocardiography on post-procedure day four revealed that the IVS had shifted toward the midline ( Figure 2D and Movie 2 ) and the LV that was ellipsoid-shaped ( Figure 2E ), demonstrated transformation to a “satisfactory configuration” (LVPWd, 3.8 mm; LVIDD, 24.3 mm; LVmi, 90 g/m 2 ) ( Figure 2F and Movie 2 ). 2) Successful arterial switch and stent explantation ( Figure 3 ) were done 17 days later. The patient's postoperative course was uneventful, with normal RV function, normal PA pressures, and minimal neo-aortic regurgitation.…”