Right transatrial approach to relieve pulmonary stenosis in patients with corrected transposition of the great vessels: A new operation without use of an extracardiac conduit

Background: A new operation to relieve pulmonary obstruction is proposed fo r patients with corrected transposition of the great vessels and pulmonary stenosis (PS). A right transatrial approach involves excising or detaching the right-sided atrioventricular valve (AV). Next, the pulmonary outflow tr act is opened wide with an incision extending from the right-sided ventricl e upward across the AV valve annulus. This incision extends into the main t runk of the pulmonary artery located behind the right atrium. A patch, with or without implantation of a pulmonary valve prosthesis, widens the outflo w tract, thus avoiding use of an extracardiac conduit. Method. We describe this operation performed in a 51-year-old man who had previously undergone correction with an extracardiac conduit that had become obstructed. The pat ient had severe right-sided AV valve insufficiency and complete heart block with a functioning transvenous pacemaker. We replaced the right-sided AV v alve and positioned the permanent pacemaker lead outside of the prosthetic skirt. The PS was corrected as described above and a pulmonary prosthetic v alve implanted. Use of an extracardiac conduit was avoided altogether. Conc lusion: This technique may be applicable even without excising the right-si ded AV valve. The clinical result for our patient is still optimal 4 years after surgery.