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.