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Effects of surgical en bloc rotation of the arterial trunk on the conduction system in children with transposition of the great arteries, ventricular septal defect and pulmonary stenosis

Published online by Cambridge University Press:  14 July 2015

Christoph Prandstetter ,
Andreas Tulzer ,
Rudolf Mair ,
Eva Sames-Dolzer  and
Gerald Tulzer
Christoph Prandstetter*
Affiliation:
Department of Pediatric Cardiology, Children’s Heart Center Linz, Linz, Austria
Andreas Tulzer
Affiliation:
Department of Pediatric Cardiology, Children’s Heart Center Linz, Linz, Austria
Rudolf Mair
Affiliation:
Department of Pediatric Cardiac Surgery, Children’s Heart Center Linz, Linz, Austria
Eva Sames-Dolzer
Affiliation:
Department of Pediatric Cardiac Surgery, Children’s Heart Center Linz, Linz, Austria
Gerald Tulzer
Affiliation:
Department of Pediatric Cardiology, Children’s Heart Center Linz, Linz, Austria
*
Correspondence to: C. Prandstetter, Department of Pediatric Cardiology, Children’s Heart Center Linz, Krankenhausstrasse 26-30, 4020 Linz, Austria. Tel: +0043 650 7715035; E-mail: [email protected]
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Abstract

Objectives

The standard surgical management of patients with transposition of the great arteries, ventricular septal defect, and pulmonary stenosis is the Rastelli operation. Recently, en bloc rotation of the arterial trunk, by cutting out the aortic and the pulmonary root in one block and by rotating it 180°, has been introduced as a new option for anatomical repair.

Methods

To evaluate the effects of this surgical method on the conduction system, pre-operative, post-operative, and follow-up electrocardiograms as well as patient charts were reviewed retrospectively. A total of 16 consecutive patients with transposition of the great arteries and left outflow tract obstruction were treated with en bloc rotation.

Results

During the post-operative period, there were two patients with complete atrio-ventricular block, one with junctional ectopic tachycardia, one with ventricular tachycardia, and one with supraventricular tachycardia. None of the patients had a typical right bundle branch block pattern before surgery; however, this pattern was detectable after surgery in eight out of 16 patients (50%), which persisted during the follow-up. All patients without typical right bundle branch block pattern showed a median QRS duration of 65 ms (54–112 ms) before surgery, 62 ms (54–122 ms) after surgery, and 84 ms (66–128 ms) at the last follow-up visit. This compares well with a similar Rastelli cohort, where a right bundle branch block prevalence of 77% was reported. Out of 16 patients, 12 showed non-specific ST changes and negative T-waves, which persisted during follow-up with an unknown significance for the future.

Conclusion

Our data suggest that en bloc rotation of the arterial trunk seems not to have more negative effects on the conduction system than the Rastelli operation.

Keywords

En bloc rotation of the truncus arteriosustransposition of the great arteriespulmonary stenosisaortic root translocationleft ventricular outflow tract obstructionRastelli procedure
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 3 , March 2016 , pp. 516 - 520
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Copyright
© Cambridge University Press 2015 

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References

1. Rastelli, GC, Wallace, RB, Ongley, PA. Complete repair of transposition of the great arteries with pulmonary stenosis. A review and report of a case corrected by using a new surgical technique. Circulation 1969; 39: 83–95.Google Scholar
2. Lecompte, Y, Neveux, JY, Leca, F, et al. Reconstruction of the pulmonary outflow tract without prosthetic conduit. J Thorac Cardiovasc Surg 1982; 84: 727–733.Google Scholar
3. Nikaidoh, H. Aortic translocation and biventricular outflow tract reconstruction. A new surgical repair for transposition of the great arteries associated with ventricular septal defect and pulmonary stenosis. J Thorac Cardiovasc Surg 1984; 88: 365–372.Google Scholar
4. Haas, GS. Advances in pediatric cardiovascular surgery: anatomic reconstruction of the left ventricular outflow tract in transposition of the great arteries with pulmonic valve abnormalities. Curr Opin Pediatr 2000; 12: 501–504.Google Scholar
5. Yamagishi, M, Shuntoh, K, Matsushita, T, et al. Half-turned truncal switch operation for complete transposition of the great arteries with ventricular septal defect and pulmonary stenosis. J Thorac Cardiovasc Surg 2003; 125: 966–968.Google Scholar
6. Lan, Y-T, Lee, JCR, Wetzel, G. Postoperative arrhythmia. Curr Opin Cardiol 2003; 18: 73–78.Google Scholar
7. Mair, R, Sames-Dolzer, E, Vondrys, D, Lechner, E, Tulzer, G. En bloc rotation of the truncus arteriosus – an option for anatomic repair of transposition of the great arteries, ventricular septal defect, and left ventricular outflow tract obstruction. J Thorac Cardiovasc Surg 2006; 131: 740–741.Google Scholar
8. Mair, R. En-bloc rotation of the truncus arteriosus – a technique for complete anatomic repair of transposition of the great arteries/ventricular septal defect/left ventricular outflow tract obstruction or double outlet right ventricle/left ventricular outflow tract obstruction. Oper Tech Thorac Cardiovasc Surg 2009; 14: 45–54.Google Scholar
9. Grosse-Wortmann, L, Kreitz, S, Grabitz, RG, et al. Prevalence of and risk factors for perioperative arrhythmias in neonates and children after cardiopulmonary bypass: continuous holter monitoring before and for three days after surgery. J Cardiothorac Surg 2010; 5: 85.Google Scholar
10. Mildh, L, Hiippala, A, Rautiainen, P, Pettilä, V, Sairanen, H, Happonen, J-M. Junctional ectopic tachycardia after surgery for congenital heart disease: incidence, risk factors and outcome. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg 2011; 39: 75–80.Google Scholar
11. Zampi, JD, Hirsch, JC, Gurney, JG, et al. Junctional ectopic tachycardia after infant heart surgery: incidence and outcomes. Pediatr Cardiol 2012; 33: 1362–1369.Google Scholar
12. Hazekamp, MG, Gomez, AA, Koolbergen, DR, et al. Surgery for transposition of the great arteries, ventricular septal defect and left ventricular outflow tract obstruction: European Congenital Heart Surgeons Association multicentre study. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg 2010; 38: 699–706.Google Scholar
13. Brown, JW, Ruzmetov, M, Huynh, D, Rodefeld, MD, Turrentine, MW, Fiore, AC. Rastelli operation for transposition of the great arteries with ventricular septal defect and pulmonary stenosis. Ann Thorac Surg 2011; 91: 188–193; discussion 193–194.Google Scholar
14. Di Carlo, D, Tomasco, B, Cohen, L, Vouhé, P, Lecompte, Y. Long-term results of the REV (réparation à l’ètage ventriculaire) operation. J Thorac Cardiovasc Surg 2011; 142: 336–343.Google Scholar
15. Hörer, J, Schreiber, C, Dworak, E, et al. Long-term results after the Rastelli repair for transposition of the great arteries. Ann Thorac Surg 2007; 83: 2169–2175.Google Scholar
16. Honjo, O, Kotani, Y, Bharucha, T, et al. Anatomical factors determining surgical decision-making in patients with transposition of the great arteries with left ventricular outflow tract obstruction. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg 2013; 44: 1085–1094; discussion 1094.CrossRefGoogle ScholarPubMed
17. Berul, CI, Hill, SL, Geggel, RL, et al. Electrocardiographic markers of late sudden death risk in postoperative tetralogy of Fallot children. J Cardiovasc Electrophysiol 1997; 8: 1349–1356.Google Scholar
18. Tzemos, N, Harris, L, Carasso, S, et al. Adverse left ventricular mechanics in adults with repaired tetralogy of Fallot. Am J Cardiol 2009; 103: 420–425.CrossRefGoogle ScholarPubMed