Abstract: Objective?To summarize the clinical experience,surgical technique and indication of coronary artery implantation with double flap extension technique in arterial switch operations (ASO) in D-transposition of the great arteries (D-TGA) and Taussig-Bing anomalies.?Methods?From January 2006 to June 2011, 21 patients (13 males and 8 females;age 110.0±84.5 d;weight 5.4±4.2 kg) with D-TGA or Taussig-Bing anomalies associated with complex coronary artery malformations underwent ASO with double flap extension technique for coronary artery implantation in Shanghai Children’s Medical Center affiliated to Medical College of Shanghai Jiaotong University. All the patients had a main trunk of right coronary artery or dilated right ventricular conus branch originated from the left or right aortic sinus,with abnormal course of anterior looping to the aorta. The double flap extension technique was described as followed: a long coronary button was excised as a flap from the aorta; another pedicle flap on the pulmonary artery (neoaorta) was cut to extend to the button of coronary artery with an equal distance; the side edges of the flap and the button were sutured together to form a lengthened coronary artery tube.?Results?No operative death occurred in hospital. The postoperative duration of mechanical ventilation was 101.6±53.6 h. The duration of ICU stay was 9.5±4.9 d. Postoperatively,low cardiac output syndrome occurred in 9 cases,pulmonary hypertension crisis in 2 cases,pneumonia in 6 cases,and acute kidney failure in 2 cases. Eleven patients underwent delayed sternum closure. All the patients were discharged after proper treatment. Follow-up was complete in 17 cases. The duration of follow-up was 2 months to 5 years. Growth and development were significantly improved in all the patients during follow-up. No patient had ischemic ECG changes. One patient underwent reoperation for supravalvular pulmonary stenosis 2 years after ASO.?Conclusion?Double flap extension technique for coronary implantation in complicated ASO can significantly decrease postoperative death due to coronary artery malformations,especially for patients who have two-stage ASO and patients whose main trunk of right coronary artery or dilated right ventricular conus branch originates from the left or right aortic sinus with abnormal course of anterior looping to the aorta.
Citation: WANG Shunmin,XU Zhiwei,LIU Jinfen,et al. Application of Double Flap Extension Technique in Complicated Arterial Switch Operation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(4): 345-349. doi: Copy