J.Jpn. Surg. Soc.. 99(2): 78-83, 1998

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Feature topic

REOPERATION AFTER REPAIR OF COMPLETE TRANSPOSITION OF THE GREAT ARTERIES

Atrial switch operation (Mustard operation, Senning operation), Rastelli operation, and arterial switch operation (Jatene operation) have been performed as definitive methods for the repair of complete transposition of the great arteries (TGA). Obstuction of the superior vena cavae and the pulmonary venous tract are common reasons for reoperation after the atrial switch operation. Stenosis of the extracardiac conduit is inevitable after the Rastelli operation is performed. Reconstruction of the right ventricular outflow tract using Danielson’s procedure may eliminate the need for rereoperation. The REV procedure at the time of initial operation may decrease the incidence of reoperation after the repair of TGA with a ventricular septal defect and left ventricular outflow tract obstruction. Pulmonary stenosis is the most common reason for reoperation after the arterial switch operation. Reconstruction of the pulmonary artery using Pacifico‘s method or the single pantaloon patch technique with autologous pericardium is expected to reduce the occurrence rate of postoperative pulmonary stenosis. Postoperative aortic regurgitation is uncommon and is usually mild in grade. However, because the pulmonary sinus is shallow and fragile compared with the aortic sinus of Valsalva, the durability of neoaortic valves remains to be elucidated during long-term follow-up.

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