Transposition of Great Arteries With Aortopulmonary Window: Our Surgical Experience

• Published in: The Annals of thoracic surgery Vol. 97; no. 1; pp. 196 - 201
• Main Authors: Mishra, Amit, MCh, FPCS, Gandhi, Hemang, MD, Sharma, Pranav, MCh, Patel, Hardik, MBBS, Parmar, Divyakant, MD, Sheth, Megha, MB, DMRD, Rodricks, Dayesh, DPT
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 2014
• Subjects: Abnormalities, Multiple - diagnosis; Abnormalities, Multiple - mortality; Abnormalities, Multiple - surgery; Age Factors; Aortopulmonary Septal Defect - diagnosis; Aortopulmonary Septal Defect - mortality; Aortopulmonary Septal Defect - surgery; Cardiothoracic Surgery; Child, Preschool; Female; Follow-Up Studies; Hospital Mortality - trends; Humans; India; Infant; Infant, Newborn; Male; Patient Safety; Postoperative Complications - mortality; Postoperative Complications - physiopathology; Risk Assessment; Sampling Studies; Surgery; Survival Rate; Transposition of Great Vessels - diagnosis; Transposition of Great Vessels - mortality; Transposition of Great Vessels - surgery; Treatment Outcome; Vascular Surgical Procedures - methods; Vascular Surgical Procedures - mortality; India; 21
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2013.07.012

Background Transposition of the great arteries with aortopulmonary window is a rare congenital cardiac anomaly. An arterial switch operation with repair of the aortopulmonary window is the preferred operation in this subset. As the tissue between the great arteries is missing, it is considered to be a complex operation. The purpose of this study is to present our experience of a simple yet highly effective surgical technique for the management of this rare complex cardiac defect. Methods We detail our experience of the surgery of this complex defect in 4 patients. Standard technique of an arterial switch operation with minor modification in excision of branch pulmonary arteries is all that is needed in approaching this complex subset. The moiety of tissue resulting from the absence of an aortopulmonary window was naturally covered by the proximal and distal neo-aortic flap tissue. The operative technique used in the 4 cases and their presentations are detailed in the text. Results Four patients of ages 28 days, 35 days, 40 days, and 6 months were successfully operated. One patient expired on postoperative day 21. In this case, advanced age of presentation, severe pulmonary artery hypertension, and sepsis possibly caused the death. The remaining 3 patients are off medication now and are being regularly followed up. Conclusions In our experience early diagnosis and an arterial switch operation have been crucial in getting a favorable outcome in planning of this complex congenital heart disease.