Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-12T21:12:32.619Z Has data issue: false hasContentIssue false

Replacement of the aortic valve after the arterial switch operation

Published online by Cambridge University Press:  18 April 2005

Vladimir Alexi-Meskishvili
Affiliation:
Department of Thoracic and Cardiovascular Surgery, and Department of Congenital Heart Disease, Deutsches Herzzentrum, Berlin, Germany
Joachim Photiadis
Affiliation:
Department of Thoracic and Cardiovascular Surgery, and Department of Congenital Heart Disease, Deutsches Herzzentrum, Berlin, Germany
Jan-Hendrik Nürnberg
Affiliation:
Department of Thoracic and Cardiovascular Surgery, and Department of Congenital Heart Disease, Deutsches Herzzentrum, Berlin, Germany

Abstract

An 11-month-old infant had undergone a primary arterial switch operation, including the Lecompte maneuver, for correction of discordant ventriculo-arterial connections and closure of an accompanying ventricular septal defect.

At discharge, there were no signs of aortic valvar incompetence. Regurgitation across the aortic valve was detected first at the age of 2 years, and then increased progressively, as documented by serial echocardiographic studies. There had been no history of bacterial endocarditis. At the age of 10 years, echocardiography revealed severe aortic valvar incompetence. At operation, the aortic valve had three leaflets, all of which were short, with very restricted movement. Absence of sufficient leaflet tissue precluded a durable valvar reconstruction, so the aortic valve was replaced with a 21 mm mechanical prosthesis. Histological examination of the removed leaflets revealed nodular swelling due to mucous changes of the matrix, as well as fibrous alteration and formation of scar tissue, including areas of fibroblastic and capillary proliferation. There were no signs of calcification or acute inflammatory changes. Improvement of left ventricular function was observed both early postoperatively and later on. Our observation shows that aortic valvar incompetence after an arterial switch operation can be caused by degenerative changes of the neo-aortic leaflets, which prevent plastic reconstruction of the valve, necessitating valvar replacement.

Type
Brief Report
Copyright
© 2003 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ungerleider RM GW, Israel P, Kanter RJ, Armstrong B. Report of neoaortic valve replacement in a ten-year-old girl after arterial switch procedure for transposition. J Thorac Cardiovasc Surg 1992; 104: 213215.Google Scholar
Seraff A RD, Lacoue-Gayet F, Touchot A, Bruniaux J, Sousa-Uva M, Planche C. Reoperation after arterial switch operation for transposition of the great arteries. J Thorac Cardiovasc Surg 1995; 110: 892899.Google Scholar
Laudito A BM, Suleman S, Bleiweis, Thopson LD, Hanley FL, Reddy VM. The Ross procedure in children and young adults: A word of caution. J Thoracic Cardiovac Surg 2001; 122: 147153.Google Scholar
Brown JW PH, Turrentine M. Arterial switch operation: Factors impacting survival in the current era. Ann Thorac Surg 2001; 71: 19781984.Google Scholar
Hourihan M M CS, Wernowsky G, Maheswari U, Mayer J, Sanders S. Growth of the aortic anastomosis, annulus, and root after arterial switch procedure performed in infancy. Circulation 1993; 88: 615620.Google Scholar
Yamaguchi M HY, Imai Y, Kurosawa H, et al. Early and midterm results of the arterial switch operation for transposition of the great arteries in Japan. J Thorac Cardiovasc Surg 1990; 100: 261269.Google Scholar
Hazekamp MG SP, Suys BE, Hutter PA, Meijboom EJ, Ottenkamp J, Huysmans HA. Switch back: using the pulmonary autograft to replace aortic valve after arterial switch operation. J Thorac Cardiovasc Surg 1997; 114: 844846.Google Scholar
Hutter PA TB, Jansen P, Hitchcock JF, Faber JAJ, Meijboom EJ, Bennik GBWE. Fate of the aortic root after arterial switch operation. Eur J Cardiothorac Surg 2001; 20: 8288.Google Scholar
Immamira M D-WJ, McCarthy JF, Mee RBB. Aortic valve repair after arterial switch operation. Ann Thorac Surg 2000; 69: 607608.Google Scholar