Modified arterial switch operation by spiral reconstruction of the great arteries in transposition

Background. Spiral relationship of the normally related great arteries (SRG A) has never been reconstructed in an arterial switch operation. Methods. From March 1998 to April 1999, 9 consecutive eases of transpositio n of the great arteries (TGA) family (from 2 days to 1.6 years old) underwe nt arterial switch operations with SRGA at our hospital. Two had a congenit ally corrected TGA (plus atrial redirection). Lecompte maneuver was not use d in all. The posterior wall of pulmonary trunk was not divided but three w ere reattached, two of whom had had previous pulmonary trunk banding. Thus the wall was shared between the great arteries facing each other. Results. All survived the operation. Supraaortic stenosis was balloon-dilat ed in 2 cases of early series, but technical modifications later were able to avoid it. Angiogram showed smooth now into SRGA without upward and anter ior tilting of the pulmonary bifurcation. All great and coronary arteries w ere patent. All were doing well on follow-up (16.5 +/- 4.2 months). Conclusions. We concluded that the techniques to relocate the coronary arte ries using common wall and in situ switch could also be applied to pulmonar y arterial reconstruction, so that SRGA can be resumed in TGA. (C) 2000 by The Society of Thoracic Surgeons.