Atrioventricular groove patch plasty for anatomically corrected malposition of the great arteries

Objective: In anatomically corrected malposition of the great arteries, dex troposition of the posterior pulmonary artery and levoposition of the anter ior aorta are associated with the leftward deviation of the proximal portio n of the right coronary artery away from the right atrioventricular groove. This anatomic feature allows a transannular subpulmonary patch plasty of t he right ventricular outflow tract along the right atrioventricular groove between the right coronary artery and the tricuspid anterior anulus (ie, at rioventricular groove patch plasty) for relief of subpulmonary stenosis wit hout jeopardizing the right coronary artery. Methods: This report describes the midterm results of a new surgical techni que, atrioventricular groove patch plasty with a monocuspid transannular pa tch for subpulmonary stenosis, in 3 patients with anatomically corrected ma lposition of the great arteries, along with a concomitant closure of ventri cular septal defects. Results: Postoperative catheterization revealed adequate relief of pulmonar y stenosis, with a pressure gradient of 8.0 +/- 3.5 mm Hg and with normaliz ed right ventricular pressure (33 +/- 10 min Hg), contributing to excellent midterm results with no late death and reoperation during a postoperative follow-up period of 70 +/- 47 months. Conclusion: This technique provides a promising alternative to Rastelli-typ e conduit repair for subpulmonary stenosis in anatomically corrected malpos ition of the great arteries.