Repair of Transposition With Absent Pulmonary Valve Using Pulmonary Artery Retrenchment Technique

Originally presented as a Surgical Motion Picture at the 2015 STSA Annual Meeting

Objectives: This video demonstrates the surgical repair of transposition of the great arteries (TGA) with absent pulmonary valve (APV) in an infant. It specifically demonstrates a technique for pulmonary artery reduction/retrenchment (PART), which is useful for aneurysmal pulmonary arteries associated with APV. The anatomy of APV is also demonstrated.

Methods: The repair is performed on cardiopulmonary bypass (CPB) with moderate hypothermia. The repair is a "Rastelli" type, including closure of a large atrial septal defect (ASD) and baffle closure of the ventricular septal defect (VSD) to create a left ventricle to aorta connection. A pulmonary artery reduction/retrenchment technique (PART), for decreasing the size of the large, aneurysmal pulmonary arteries is demonstrated and right ventricle to pulmonary artery continuity is completed with a pulmonary homograft.

Results: The patient tolerated the procedure well and was returned to the ICU on minimal inotropic support and with excellent hemodynamics.

Conclusion: TGA/APV is a rare variant of APV syndrome. A Rastelli type repair is demonstrated and the technique of pulmonary artery retrenchment is a useful and easily reproducible method for geometric diminution of aneurysmal pulmonary arteries.

Copyright 2015, used with permission from the Southern Thoracic Surgical Association. All rights reserved.