Akademik Veri Yönetim Sistemi
19th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY, İstanbul, Türkiye, 4 - 06 Kasım 2023, cilt.11, sa.1, ss.26-28, (Özet Bildiri)
OBJECTİVE: We present here a novel surgical technique for repairing post-operative supravalvular pulmonary stenosis that occurred after arterial switch operation for TGA. We have operated three cases so far with this technique. METHODS: The last case was ten and half months old male baby with moderate malnutrition who had arterial switch operation at the second day of his life. Echocardiography revealed severe supravalvular pulmonary stenosis with 75 mmHg gradient. Also severe tricuspid regurgitation was found. We planned performed peripheral cannulation and put the patient on CPB before starting re sternotomy as a novel technique. Also whole operation was planned as beating hearth without aortic cross clamping avoiding further dissection around the aorta. The inferior and superior vena cava are tightened for total CPB. After clear exposure, small incision was performed. Through this pulmonary incision first venting cannula inserted into right ventricle and further incision towards pulmonary artery. A second venting cannula was placed distal to the pulmonary artery at this stage for excellent exposure. Hegar dilator was applied and suturing of the bovine pericardial patch started at the annulus of the native previously dilated pulmonary artery. We kept the both venting cannulas in situ until the very end of the anastomosis in order to have this bloodless clear exposure until the last suture. Then modified De-vega annuloplasty was performed for tricuspid regurgitation. You can find the procedure details in this video. RESULTS: Patient was in a good hemodynamic condition after coming off bypass. The previous two cases that we apply the same technique and also perfect post-operative outcome. Table-1: Clinical characteristics of patients operated on using the novel surgical technique Clinical information Case 1 Case 2 Case 3 Personal information Five years old male Dyspnea Three years old male Ten and half months old male Complaint Medical history Dyspnea, cough Arterial switch operation at second day of his life Supravalvular pulmonary gradient: 92 mmhg Arterial switch operation at first day of his life Vomiting, malnutrition Arterial switch operation at second day his life Echocardiograph y Post-operative condition Supravalvular pulmonary gradient: 128 mmhg Discharged at 10th post-operative day with no symptoms Discharged at 15th post-operative day with no symptoms Supravalvular pulmonary gradient: 75 mmhg Discharged at 7th post operative day with no symptoms *The first congenital pathology of these cases is transposition of the great arteries. **In these cases, cardiopulmonary by-pass was started with peripheral cannulation before resternotomy ***These cases were performed on a beating heart and two venting cannulas were used, no cross clamps were used CONCLUSIONS: TGA is the most common cyanotic congenital heart disease and arterial switch operation is preferred for surgical correction1. Stenosis is due to undergrowth of the supravalvular neopulmonary anastomosis scar. Most common indication for cardiac re-operation in the first year of life.2 Dyspnea, cyanosis, fatigue occurs, the diagnosis is usually made echocardiagraphically.3 There are difficulties due to re-operation and pediatric cases. Risk of cardiac injury during re-sternotomy and adhesions around the great vessels due to previous operation are examples of these.4 In these cases, the risk of cardiac injury was reduced by decompressing the right ventricle with the peripheral cannulation before re-sternotomy. There was no myocardial protection problem in our procedure, as it was completed without the use of cross clamp on beating heart. Using two different vent cannulas also provided bloodless exposure. Our technique is effective, safe and reproducible in repairing postoperative supravalvular pulmonary stenosis.