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Letter From the Guest Editor: Advances in Surgical Treatment of Complex Conotruncal Malformations
For CTSNet's first Congenital Guest Editor Series, Advances in Surgical Treatment of Complex Conotruncal Malformations, we asked Dr Viktor Hraska of the Herma Heart Center at the Medical College of Wisconsin to bring together videos from experts focused on techniques for improving patient outcomes in the face of these rare but serious conditions.
This series elaborates different surgical approaches to complex conotruncal malformations, using the principle of posterior translocation of the aorta or en bloc rotation of the outflow tracts. These procedures simplify reconstruction of the outflow tracts in complete transposition of the great arteries with ventricular septal defect and complex left ventricular outflow tract obstruction.
The divided outlet septum offers excellent visualization of the atrioventricular valve attachments and the ventricular septal borders. Therefore, the development of an unobstructed left ventricular outflow tract with the patch is easier, even if there is complete atrioventricular canal defect or atrioventricular valve straddling. The translocated aorta is directly committed to the left ventricle, thus avoiding the problems with left ventricular outflow tract obstruction seen in intraventricular baffles. This may translate into better left ventricle performance and thus better actuarial survival. On the top of that, en bloc rotation might provide a more physiological right ventricle outflow tract as well. Nonetheless, these are complex operations and they call for a careful selection of patients.
Dr Viktor Hraska
En Bloc Rotation of the Outflow Tracts: An Option for Anatomic Repair of Complex Transposition
by Rudolf Mair, Eva Sames-Dolzer, Michaela Innerhuber, Peter Benedikt
by Victor Morell
Expanding the Limits of Posterior Aortic Translocation
by Viktor Hraska, Michael Madrzak