Modified Nikaidoh procedure in a patient with transposition of the great arteries, ventricular septal defect, and left ventricular outflow tract obstruction with unusual coronary anatomy

Abstract

The Rastelli operation has been the most common procedure for the repair of transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction. A relatively recent approach is the Nikaidoh procedure. Despite the fact that it seems promising, the operation lacks long-term follow-up data. It has been postulated that patients with anomalous coronary arteries are high-risk candidates for the Nikaidoh procedure and its modifications. In this report, we present the case of a patient with transposition of the great arteries with remote restrictive ventricular septal defect and left ventricular outflow tract obstruction with coronary anomaly - with the right coronary artery originating from the left anterior descending coronary artery and crossing the right ventricular outflow tract - who underwent successful modified Nikaidoh operation.

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“…In such situations, it may sometimes be the only option for biventricular correction [17][18][19]. It is believed that abnormal distribution of the coronary arteries constitutes a contraindication for the Nikaidoh procedure, but, in 2011, the journal Cardiology in the Young published a description of a successful operation with this technique performed in a patient whose anterior interventricular branch of the left coronary artery crossed the right ventricular outflow tract [20].…”

“…This type of anatomy may also prevent the transplantation of coronary arteries in conjunction with aortic translocation. In such situations, the Rastelli procedure seems to be a better option [19][20][21][22].…”

“…Each of these three options for surgical treatment has found a place in cardiac surgery, and the choice of an optimal method may sometimes be controversial with regard to mortality rates and long-term outcomes. However, for the vast majority of centers in the world, the Rastelli procedure still remains the method of choice [19][20][21][22].…”