Extending the concept of the autograft for complete repair of transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction: A report of ten cases of a modified procedure

Abstract

This modification of the Lecompte operation using a segment of autograft allows an excellent early and late result, with no danger of compression of anteriorly placed pulmonary arteries, no significant right ventricular outflow obstruction, and normal appearance of the tubular autograft. In view of laboratory and clinical evidence, normal growth of the autograft can be anticipated. It allows an elective correction of transposition, ventricular septal defect, and left ventricular outflow tract obstruction without a previous Blalock-Taussig shunt (three patients) and correction at a young age (three patients younger than 1 year).

Restoration of Transposed Great Arteries With or Without Subpulmonary Obstruction to Nature

“…This advantage of aortic shortening is also observed in patients undergoing Nikaidoh operation (Morell & Wearden, 2006). We agree with Metras and coworkers (Metras et al, 1997) that Lecompte maneuver to mobilize the pulmonary bifurcation anterior to the aorta is unnecessary. This is because if the pulmonary bifurcation is left in situ as it is originally by nature, the chance for developing supravalvular PS may decrease (Chiu et al, 2000b;Chiu et al, 2002b).…”

“…This is because if the pulmonary bifurcation is left in situ as it is originally by nature, the chance for developing supravalvular PS may decrease (Chiu et al, 2000b;Chiu et al, 2002b). Our direction for placement of a free graft of this curved aortic segment is opposite to that proposed by Metras (Metras et al, 1997). Follow-up CT showed satisfactory result (Figure 9).…”

Left ventricular outflow tract obstruction after arterial switch operation

“…The classical contraindication to ASO is a hypoplastic pulmonary annulus, or a LVOTO considered as non-resectable. Then, other strategies can be used as Rastelli, Lecompte or Metras procedures [2][3][4]12], but they require the presence of a large subpulmonary ventricular septal defect. These procedures are not always feasible and have their drawbacks such as reoperations for conduit replacement or pulmonary regurgitations in case of repair without valved conduit.…”

“…These anomalies can be secondary to conal septum malalignment, accessory mitral tissue, muscular bundle hypertrophy or abnormal tricuspid chordae attachments [1]. Although transposition of the great arteries associated to LVOTO is better approached by the Rastelli procedure [2], with Lecompte [3] or Metras [4] procedure, or by aortic root translocation described by Nikaidoh [5][6][7], in some patients resection of the cause of LVOTO is feasible and the arterial switch procedure may offer an anatomical and definitive result in most cases [8,9]. However, despite resection of the obstacle and attention not to narrow LVOT at initial surgery, a subaortic stenosis may appear or reappear.…”

The Use of Valved Conduits in Pediatric Cardiac Surgery

“…Some surgeons were worried about early obstruction of conduits and suggested repairs that avoided their use. The operation proposed by Lecompte et al [21] is one option; another is the modification using the interposition of an aortic autograft, as described by Metras et al [22].…”