Original articlePediatric cardiacThe Rastelli Procedure for Transposition of the Great Arteries: Resection of the Infundibular Septum Diminishes Recurrent Left Ventricular Outflow Tract Obstruction Risk
Section snippets
Patients and Methods
Approval of this study was obtained from the Research Ethics Board at our institution, and requirement for individual consent was waived for this observational study.
Results
The study included 36 consecutive patients (21 boys, 15 girls) with d-TGA, VSD and PS. Median age was 2.4 years (range, 111 days to 8.3 years). Pulmonary stenosis was present in 31 patients and pulmonary atresia in 5. Twenty-two patients had undergone a previous aortopulmonary shunt, and 6 had a previous atrial septectomy. Additional cardiac anomalies included 3 with multiple VSDs, 2 with dextrocardia, and 1 patient each with total anomalous pulmonary venous connection, coarctation of the
Comment
The Rastelli procedure was first introduced in 1969 and soon became the conventional surgical management for patients with d-TGA, VSD, and PS [1, 2]. Nonetheless, published clinical data have shown the long-term results of the Rastelli procedure are far from optimal, with diminished long-term survival, depressed ventricular function, and increased reintervention on the RVOT or LVOT [3, 4, 5, 6].
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Cited by (27)
Fate of the Left Ventricular Outflow Tract After Rastelli With Selective Infundibular Muscle Resection
2019, Annals of Thoracic SurgerySelective management strategy of interrupted aortic arch mitigates left ventricular outflow tract obstruction risk Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015.
2016, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Unfortunately, that case was complicated by injury to the neoaortic valve that required valve replacement and was associated with a late death. The low incidence of baffle obstruction in our series echoes results in cases with the Rastelli procedure, in which routine enlargement of the ventricular septal defect at the time of repair has been shown to decrease late LVOTO risk.30 The risk of LVOTO after LVOT bypass in our series was low, similar to results from several other institutions, indicating that this approach is very effective in mitigating the risk of LVOTO in patients with anatomic substrate to develop LVOTO after IAA repair.
Discussion
2016, Journal of Thoracic and Cardiovascular SurgeryCT imaging in congenital heart disease: An approach to imaging and interpreting complex lesions after surgical intervention for tetralogy of Fallot, transposition of the great arteries, and single ventricle heart disease
2013, Journal of Cardiovascular Computed TomographyCitation Excerpt :These lesions are considered complex transposition. When pulmonary stenosis or atresia is present, the valve can be oversewn and the VSD is baffled to the aorta via the right ventricle, and a conduit is placed to the distal PA (Rastelli procedure).27–29 The Rastelli procedure is commonly performed for d-TGA with VSD and pulmonary atresia or for double outlet right ventricle with pulmonary stenosis or pulmonary atresia (Fig. 11).
Rastelli operation for transposition of the great arteries with ventricular septal defect and pulmonary stenosis
2011, Annals of Thoracic SurgeryCitation Excerpt :The early mortality of the RO has been reduced to less than 5% in the majority of institutions [7, 10, 11]. Most patients will require reoperation for conduit change, but these procedures are currently performed with a low morbidity and mortality [7, 10, 11, 20]. Aggressive resection of the anterosuperior portion of the ventricular septum to enlarge the VSD has nearly eliminated the need for LVOTO reoperation in most series [7, 8, 10].