Ventricular Septation and Arterial Switch for an Infant with Double Inlet Left Ventricle, Transposition of Great Arteries and Partial Anomalous Pulmonary Venous Return

Yu-Ting Lin, Shu-Chien Huang, Shyh-Jye Chen, Yih-Sharng Chen

National Taiwan University Hospital, Taipei, Taiwan

Date, time and location: 2018.05.25 15:30, Press Hall, 2F

Abstract

Patients with univentricular heart usually received single ventricle reconstruction. However, in certain cases, bi-ventricular repair is feasible. We present a complex bi-ventricular repair for an infant with double inlet left ventricle(DILV), transposition of great arteries (TGA), and partial anomalous pulmonary venous return (PAPVR)

This is an 6-month-old girl with post-natal diagnosis of DILV-TGA. She received PDA ligation and main pulmonary artery banding, balloon septostomy as initial palliation. In the follow-up, distal migration of banding causing right pulmonary artery stenosis and restricted atrial septal defect made the her oxygenation saturation sub-optimal. Failure to thrive and cardiomegaly were also noted. The cardiac CT and cardiac cath also showed a left upper pulmonary vein to innominate vein (PAPVR). Since the four cardiac valves are normal in size, we suggested bi-ventricular repair for this baby. The surgery was performed with standard cardiopulmonary bypass and aorta crossclamped. Left upper pulmonary vein was opened and sutured to left atrial appendage to correct PAPVR first. The arterial switch operation was performed as usual manner, with the banded pulmonary artery segment divided and opened. The both AV valve were checked, and the chordea of her septal leaflet of tricuspid valve(TV) were originated from left side papillary muscle along with the mitral valves. Ventricular septation was performed with a Darcon patch, which was sutured from apex to inferior ventricular wall, then from apex to cephalic direction on the conal septum. The patch was trimmed to appropriate size and shape before suture on the septal leaflets of TV. The TV was repaired to competent. Finally, the pulmonary artery was reconstructed with a pericardial patch; The bypass and crossclamp duration were 344 and 226 minutes, respectively. The followed echo showed trivial mitral regurgitation, mild tricuspid regurgitation, mild right PA stenosis and mild neo-aortic regurgitation. The patient recovered well with normal growth and activity.