Case Report
A fetus was diagnosed as having DORV with subpulmonary ventricular
septal defect (VSD). The baby was born by the Caesarean section
(gestational age 38 weeks and 1day, body weight 3.4 kg, female). Her
oxygen saturation was 85%. The arterial duct was maintained on
Prostaglandin. Balloon atrio-septostomy was not carried out. Left and
right ventriculography exclusively enhanced streaming to the pulmonary
trunk and the aorta, respectively. On computed tomography (CT), the
aortic valve was right-anterior to the pulmonary valve. The right
ventricular (RV) outflow tract was widely patent to either of the
semilunar valves. The aortic arch was right-sided. We judged that
neonatal primary repair was sensible switching the great arteries.
Surgery was carried out at 17 days old. The architecture of the RV could
not be visualized via the tricuspid valve, but identified through a RV
incision. The anterior limb of the trabeculo-septo-marginalis sit
between the pulmonary valve and the rim of the interventricular
communication (typical for DORV with a non-committed VSD). The outlet
septum was entirely lacking; the aortic and the pulmonary valves
possessed equivalent diameters and fibrous continuity without offsetting
(a feature of DORV with a doubly-committed VSD) 1.
The VSD was enlarged antero-superiorly by the wedge resection of the
septal muscle. Interventricular rerouting was achieved, from the left
ventricle (LV) to the morphologically pulmonary valve, using an oval
polytetrafluoroethylene patch [Figure 1]. Particular attention was
paid when putting stitches to the fibrous tissues between the semilunar
valves; no pledgets were placed so as not to interfere motion of the
leaflets. The arterial switch was completed in a standard way with the
Lecompte maneuver. Placing the arterial cannula high and mobilizing the
ascending aorta extensively, right aortic arch did not matter the
arterial switch.
Postoperative CT showed excellent results a month after repair.
Transthoracic echocardiography demonstrated widely patent coronary
arteries. Flow was not accelerated across the intraventricular tunnel or
the pathway from the RV to the neo-pulmonary trunk. No residual shunts.
No tricuspid valvar impediments thus far.