MODIFIED SURGICAL TECHNIQUES FOR RELIEF OF AORTIC OBSTRUCTION IN (S,L,L) HEARTS WITH RUDIMENTARY RIGHT VENTRICLE AND RESTRICTIVE BULBOVENTRICULAR FORAMEN

Modified techniques of aortopulmonary anastomosis were performed in si x neonates with atrioventricular and ventriculoarterial discordance {S ,L,L}, double-inlet left ventricle, and restrictive bulboventricular f oramen area (mean index 1.10 cm(2)/m(2)) with unobstructed aortic arch (n = 3) or with hypoplasia (n = 2) or interruption (n = 1) of the aor tic arch, In cases of unobstructed aortic arch, a flap of autogenous a ortic tissue was used to augment the posterior aspect of the anastomos is of the main pulmonary artery to the ascending aorta, thus creating the potential for anastomotic growth; this technique is applicable reg ardless of the position of the ascending aorta relative to the main pu lmonary artery, In case of levotransposition of the aorta with hypopla sia or interruption of the aortic arch, a modified Norwood procedure w as performed, in that the proximal ascending aorta was divided at the same level as the main pulmonary artery with subsequent homograft patc h augmentation from the main pulmonary artery-ascending aorta anastomo sis to the level of the proximal descending aorta; this technique avoi ds a spiraling incision of the aorta and therefore reduces the risk of torsion of the aortic root with its inherent risks of obstruction of the coronary circulation and aortic or pulmonary valve regurgitation, There was no early or late mortality, At a mean follow-up of 16 months , in all patients, there was unobstructed aortic outflow, as evidenced by echocardiographic absence of a significant ventricular-aortic syst olic gradient (mean 4.5 +/- 4 mm Hg) and absence of distal aortic arch obstruction, There,vas no evidence of aortic or pulmonary valve regur gitation, The reported modified techniques provide effective relief of restrictive bulboventricular foramen and aortic obstruction in {S,L,L } hearts.