Late Results of Half-Turned Truncal Switch Operation for Transposition of the Great Arteries

Hongu, Hisayuki; Yamagishi, Masaaki; Miyazaki, Tatsuya; Maeda, Yoshinobu; Taniguchi, Satoshi; Asada, Satoshi; Fujita, Shuhei

doi:10.1016/j.athoracsur.2018.06.021

Cited by 17 publications

(10 citation statements)

References 28 publications

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“…The aortic translocation procedure for TGA and TGA-type DORV with left ventricular outflow obstruction offers decisive advantages in preserving growth potential, a fluid dynamically superior configuration 18) , and avoidance of late complications and re-intervention. The midterm and late results for the Nikaidoh operation 19) and the half-turned truncal switch operation 20) were thoroughly satisfactory. We have previously demonstrated the fluid dynamic supremacy of the half-turned truncal switch operation compared to conventional operations using time-resolved 3-dimensional magnetic resonance phase-contrast imaging 18) .…”

Section: Discussionmentioning

confidence: 89%

Half-Turned Truncal Switch Operation for Transposition of The Great Arteries with Left Ventricular Outflow Obstruction

Yamagishi

2021

Operative Techniques in Thoracic and Cardiovascular Surgery

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To address various problems with conventional surgical procedures for transposition of the great arteries with left ventricular outflow obstruction, the aortic translocation procedure has been reconsidered as an alternative surgical procedure. We developed another innovative translocation technique, the half-turned truncal switch operation, to make use of various anatomical characteristics. The truncal block involving both semilunar valves is harvested en bloc and anastomosed to the opposite ventricular outflow tract after a half-turn. Temporarily detached coronary arteries are re-anastomosed to the reversed aortic wall defects. The key advantage of this half-turned truncal switch operation is the creation of hemodynamically faultless right and left ventricular outflow tracts including competent valve functions and a coronary circulation ensured by the posteriorly translocated aortic valve, the maximally used autologous pulmonary valve, and anastomosis of the coronary arteries to the confronting aortic wall defects.

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Section: Discussionmentioning

confidence: 89%

Half-Turned Truncal Switch Operation for Transposition of The Great Arteries with Left Ventricular Outflow Obstruction

Yamagishi

2021

Operative Techniques in Thoracic and Cardiovascular Surgery

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“…The conventional approach to anatomic surgical repair in patients with DORV (TGA type) or TGA with VSD, and PS is the Rastelli or Lecompte procedure. However, these procedures have several serious drawbacks related to an earlier need for reinterventions or reoperation of the RVOT and a higher incidence of subaortic tunnel obstruction [1,9]. To overcome these drawbacks, Nikaidoh reported a successful anatomic repair of the aortic root translocation without individual coronary artery transfer and biventricular outflow reconstruction for these patients in 1984, and thereafter, other modified operative methods of the aortic root translocation have been proposed [10].…”

Section: Discussionmentioning

confidence: 99%

“…To overcome these drawbacks, Nikaidoh reported a successful anatomic repair of the aortic root translocation without individual coronary artery transfer and biventricular outflow reconstruction for these patients in 1984, and thereafter, other modified operative methods of the aortic root translocation have been proposed [10]. However, the Nikaidoh operation carries a high risk of stretch or distortion of the coronary arteries in patients with a relatively large pulmonary annulus because the distance of the posterior transition of the aortic root depends on the size of the pulmonary annular diameter [1]. The HTTSO was designed for straight and non-obstructive LVOT and RVOT by using an autologous half-turned truncal block that involves both aortic and pulmonary valves.…”

Section: Discussionmentioning

confidence: 99%

“…The half-turned truncal switch operation (HTTSO) was first reported by Yamagishi and colleagues in 2003 as an alternative to the Rastelli, the Lecompte, and the Nikaidoh procedures for patients with double outlet right ventricle (DORV, transposition of the great arteries [TGA] type) or TGA with ventricular septal defect (VSD), and pulmonary stenosis (PS) [1,2]. The advantages of the HTTSO are avoidance of late left ventricular outflow tract (LVOT) obstruction or right ventricular outflow tract (RVOT) obstruction and stretch or distortion of the coronary arteries.…”

Section: Introductionmentioning

confidence: 99%

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Half-turned truncal switch operation after single ventricle palliation in a patient with borderline left heart hypoplasia

Jung

Cho

et al. 2020

J Cardiothorac Surg

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Background The optimal surgical strategy for the correction of double outlet right ventricle (DORV, transposition of the great arteries [TGA] type) or TGA with ventricular septal defect (VSD), pulmonary stenosis (PS), and borderline small left ventricle (LV) is still controversial. The half-turned truncal switch operation (HTTSO) introduced by Yamagishi and colleagues is a good option, but it is still challenging in a patient with borderline small LV. We aimed to describe our experience of a case of HTTSO conversion from single ventricle palliation. Case presentation A 5-year-old girl with single ventricle physiology was referred to our hospital from Kazakhstan for a Fontan operation. At the time of birth, she was diagnosed with DORV (TGA type), PS, and situs inversus totalis, with moderate valvar and subvalvar stenosis and a relatively small LV cavity. Her LV volume was not adequate to support the systemic circulation; therefore, doctors in Kazakhstan selected the single ventricle palliation course of treatment for the infant. At 4 months of age, she underwent left-sided modified Blalock-Taussig shunt, patent ductus arteriosus ligation, and atrial septectomy. At 2 years of age, shunt takedown, left bidirectional cavopulmonary shunt, and main pulmonary artery division were performed. Annual echocardiography of the patient showed that the LV size was growing too adequately to persist with the single ventricle palliation course of treatment. Via a multidisciplinary approach, we considered her LV to be suitable for biventricular repair and HTTSO was planned. The operation and postoperative course were uneventful. The patient was discharged on postoperative day 6 and went back to Kazakhstan. Conclusions Based on our successful surgical outcome, in patients diagnosed with DORV (TGA type) or TGA with VSD, PS, and borderline LV, HTTSO after achieving adequate LV growth by single ventricle palliation may be considered a good alternative to conventional operations in patients at a high risk for initial biventricular repair.

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“…Even the group of conotruncal anomalies such as complex transpositions of great vessels (TGA) becomes an area of increasing application of the most advanced CCTA methods (76). Many complex surgical procedures actually adopted for anatomical correction of complex TGA can be indicated and guided by advanced modalities of CCTA imaging (76,77).…”

Section: Perioperative Assessment Of Congenital Heart Defectsmentioning

confidence: 99%

Cardiac CT angiography: normal and pathological anatomical features—a narrative review

Clemente

Seitun

Mantini

et al. 2020

Cardiovasc Diagn Ther

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The normal and pathological anatomy of the heart and coronary arteries are nowadays widely developed topics and constitute a fundamental part of the cultural background of the radiologist. The introduction of cardiac ECG-gated synchronized CT scanners with an ever-increasing number of detectors and with increasingly high structural characteristics (increase in temporal resolution, increase in contrast resolution with dual-source, dual energy scanners) allows the virtual measurement of anatomical in vivo structures complying with heart rate with submillimetric precision permitting to clearly depict the normal anatomy and follow the pathologic temporal evolution. Accordingly to these considerations, cardiac computed tomography angiography (CCTA) asserts itself as a gold standard method for the anatomical evaluation of the heart and permits to evaluate, verify, measure and characterize structural pathological alterations of both congenital and acquired degenerative diseases. Accordingly, CCTA is increasingly used as a prognostic model capable of modifying the outcome of diseased patients in planning interventions and in the post-surgical/interventional follow-up. The profound knowledge of cardiac anatomy and function through highly detailed CCTA analysis is required to perform an efficient and optimal use in real-world clinical practice.

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Late Results of Half-Turned Truncal Switch Operation for Transposition of the Great Arteries

Abstract: HTTSO is useful for TGA with LVOT obstruction, ensuring wide, straight ventricular outflow tracts and growth potential.

Cited by 17 publications

References 28 publications

Half-Turned Truncal Switch Operation for Transposition of The Great Arteries with Left Ventricular Outflow Obstruction

Half-Turned Truncal Switch Operation for Transposition of The Great Arteries with Left Ventricular Outflow Obstruction

Half-turned truncal switch operation after single ventricle palliation in a patient with borderline left heart hypoplasia

Cardiac CT angiography: normal and pathological anatomical features—a narrative review

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