The Cases of Total Correction for Corrected Transposition of the Great Arteries after the Reconstruction of the Left Pulmonary Artery Using Heterologous Pericardial Conduit / 日本心臓血管外科学会雑誌

We report two surgical cases with corrected transposition of the great arteries associated with ventricular septal defect and pulmonary atresia undergoing total correction including reconstruction of the central pulmonary artery after reconstruction of the left pulmonary artery for non-confluent pulmonary arteries. Both patients underwent reconstruction of the left pulmonary artery using 13 or 12mm diameter heterologous pericardial conduit at age of 5 year, respectively. At surgery, after the left pulmonary artery was exposed between the upper and lower lobe of the left lung, the conduit was connected with the left pulmonary artery along the pericardium. Continuity between the conduit and the left subclavian artery or the ascending aorta was established with 5 or 6mm diameter Micronit grafts, respectively. Total correction was performed at 2 years and 10 months after the initial surgery, respectively. In a patient with {I, D, D} type corrected transposition of the great arteries, the central pulmonary artery was established with another 16mm diameter heterologous pericardial conduit, which ran in front of the left superior vena cava. The ventricular septal defect was closed via the right atrium. In another patient with {S, L, L}, the central pulmonary artery was established with the reconstructed conduit of the left pulmonary artery, which ran behind the left phrenic nerve. The ventricular septal defect was closed via the right atrium with the De Leval procedure. In both patients, continuities between the left ventricle and the central pulmonary artery were established with tricuspid valved porcine pericardial conduit and equine pericardial conduit. Postoperatively both patients had uneventful recovery with left ventricular/right ventricular systolic pressure ratios of 0.4 and 0.35, respectively.

Percutaneous Delayed Closure of the Vertical Vein for Severe Left-Sided Heart Failure after Repair of the Total Anomalous Pulmonary Venous Drainage / 日本心臓血管外科学会雑誌

A 31-day-old infant with total anomalous pulmonary venous drainage (type I-A) suffered from severs left-sided heart failure unable to be weaned from cardiopulmonary bypass (CPB) after total repair. By reopening the vertical vein, the CPB was successfully terminated and the sternum was closed primarily. Percutaneous delayed closure of the vertical vein by lifting up the string which had been encircled the vertical vein at the time of repair was performed 3 days after repair. Systemic arterial pressure and left atrial pressure were unchanged after closure of the vertical vein. Postoperative cardiac study revealed satisfactory result and no left-to-right shunt through the vertical vein.