The term 'double-outlet left ventricle' (DOLV) denotes congenital heart malformations in which the aorta and the pulmonary trunk both arise entirely or predominantly above the morphologically left ventricle. In the past, the formal pathogenesis of DOLV was explained by an abnormal topogenesis of the origin of the great arteries, which ...

BACKGROUND: The neural crest influences the differentiation of the branchial arches, including the precursor tissue of the cardiac outflow tract and the eustachian tubes. Abnormal eustachian tubes are associated with otitis media. We hypothesized a relationship between conotruncal anomalies and eustachian tube anomalies. METHODS: We surveyed 115 nonsyndromic patients, aged ...

No method of classifying pulmonary fissures currently exists, however, the nature of the fissure is of great importance in planning operative strategy for thoracoscopic pulmonary resection where an incomplete fissure may contribute to post-operative air leakage. In order to provide a framework for description of operative technique and to allow ...

This retrospective study attempts to assess the growth pattern of the aorta and the coronary arteries and the left ventricular function approximately 1 year after neonatal arterial switch operation for simple transposition of the great arteries. Seventy-one patients underwent cardiac catheterization and cineangiocardiography an average of 13.5 months after the ...

We describe two cases of left-side pulmonary vein obstruction observed after the arterial switch operation (Jatene) for D-transposition of the great arteries. This appears to be related to left-sided pulmonary vein obstruction occurring coincidently with D-transposition of the great arteries, rather than a consequence of arterial switch operation.

A case report of difficult sternal closure is described. Chest closure following cardiac operation in critically ill patients can be a problem. Techniques have been described so that sternal closure can be delayed until the patient is hemodynamically stable and hemostasis has been achieved. However, in some instances, the sternal ...

Between January 1989 and February 1995 a group of 47 consecutive infants aged 31-180 days (mean 83.5 +/- 48.8 days) with various cyanotic heart diseases and poor intracardiac mixing underwent balloon atrial septostomy (BAS) under two-dimensional (2D) echocardiographic control in the procedure room or intensive care unit. Diagnoses were 27 ...

OBJECTIVES: The purpose of this study was to determine the diagnostic accuracy of fetal echocardiography in evaluating anatomic details of the single ventricle heart and the outcome of fetuses diagnosed with this anomaly. STUDY DESIGN: This is a retrospective study of 57 fetuses in which the results of fetal echocardiography ...

OBJECTIVE: Of all fetal malformations, those affecting the heart, particularly the great arteries, are most commonly overlooked during obstetric sonography. The appearance of normally related great arteries in the fetus is described. Abnormal parallel great artery orientation was detected on sonography in 24 fetuses over a 3-year period. This abnormality ...

Transposition of the great arteries with [S, D, L] segmental anatomy is a rare complex congenital heart lesion. The morphologic features of this unusual disease make surgical repair more challenging than in [S, D, D] transposition. Here reported is the experience with the surgical treatment of this pathologic condition in ...

We report the first case of a wide, iatrogenic, proximal disruption of the right external iliac artery, occurring during staging open lymph node dissection for prostate cancer, which was repaired by hypogastric artery transposition. The hypogastric artery was mobilized and rotated anteriorly, and sutured to the distal segment of the ...

The patient, a 17 year old boy, had undergone a Rastelli operation for transposition of the great arteries plus ventricular septal defect and left ventricular outflow tract obstruction at the age of 7 years. Associated tricuspid valve stenosis was treated with insertion of a second homograft shortly after the Rastelli ...

During the 1960s, the Mustard or Senning operation was the conventional palliative therapy for patients with transposition of the great arteries. Many of these patients are now adults, and the durability of the morphologic right ventricle to function as the systemic ventricle is being questioned. Surgical options for such adult ...

BACKGROUND: Less than perfect coronary artery translocation accounts for the majority of perioperative deaths after the arterial switch procedure for transposition of the great arteries. Some types of coronary arterial anatomy are associated with a higher risk of death. METHODS: Prospective epicardial ultrasound examination of all neonates with failing left ...

BACKGROUND: Until recently closure of the pulmonary valve during staged Fontan-type palliation in the setting of double-inlet left ventricle with an unrestrictive or adequately enlarged ventricular septal defect and transposition of the great arteries with the aorta on a left-sided outflow chamber was regarded as an appropriate part of surgical ...

A 65-year-old female was hospitalized for syncope due to new onset complete heart block. An apical holosystolic murmur was detected on physical examination. Echocardiography revealed corrected transposition of great arteries, and Ebstein-like anomaly with regurgitation at the left-sided tricuspid valve. A single chamber (VVI) pacemaker was implanted and patient has ...

OBJECTIVE: Arterial switch operation (ASO) is the procedure of choice for the repair of simple d-transposition of the great arteries (TGA) during the neonatal period. Beyond this time such correction is performed in two stages. The first step incorporates banding of the pulmonary artery with or without a Blalock-Taussig shunt ...

The arterial switch operation is appropriate treatment for most forms of transposition of the great arteries. In this review we analyze indications, techniques, and outcome for various subsets of patients with transposition of the great arteries, including those with an intact septum beyond 21 days of age, intramural coronary arteries, ...

BACKGROUND: The relationship of short-axis aortopulmonary rotation (APR) with juxtacommissural origin of the coronary arteries (JOCA) in transposition of the great arteries (TGA) has never been elucidated. The surgical outcome of arterial switch operation (ASO) is influenced by the presence of JOCA. METHODS: Fifteen patients with TGA who presented to ...

Aneurysm of the membranous ventricular septum causing subpulmonic obstruction in patients with corrected transposition is rare but well documented. Higher left-sided (morphologic right) ventricular pressure causes protrusion of the aneurysm into the pulmonary outflow tract of the right-sided morphologic left ventricle, causing obstruction related to lack of conus and proximity ...

Today, the arterial switch operation is the treatment of choice for patients with transposition of the great arteries. Midterm follow-up confirms the initial hopes for good systemic ventricular function and lack of arrhythmias. A two-stage operation can be performed in patients seen after 1 month of age or in subjects ...

Cardiac catheterization facilitates the assessment of left ventricular function in coronary artery disease (CAD). Digital left ventriculography offers the potential for an on-line quantitative determination of left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV). These are routinely evaluated by the area-length method (ALM), which is considered as ...

Paraplegia after an open heart operation in a neonate is a rare complication. We report a case of a infant in whom paraplegia developed after a successful arterial switch operation for transposition of the great arteries. The infant was monitored and resuscitated in the preoperative period with umbilical arterial and ...

Our objective was to describe the appearance of atresia of the left-sided atrioventricular valve on the four-chamber view of the fetal heart. Twenty-four cases of atresia of the left-sided atrioventricular connection were detected over a 2-year period. Cases were analyzed according to the appearance of the four-chamber view and the ...

OBJECTIVE: The purpose of this original report is to describe medial transposition of the common carotid arteries. This transposition may produce wide retropharyngeal soft tissues on lateral cervical radiographs. CONCLUSION: When common carotid arteries are transposed from their normal lateral positions into the retropharyngeal soft tissues, if vascular calcifications are ...

We describe a 59-year-old patient with Holmes heart (single ventricle with normally related great arteries). To our knowledge, this is the oldest patient in the literature with this rare congenital heart disease and the oldest one with single ventricle and unrestricted pulmonary blood flow who has developed Eisenmenger's physiology. A ...

The purpose of this study was to determine the sensitivity and specificity of echocardiography for the diagnosis of congenital cardiac abnormalities with multiple lesions. The study was carried out on 80 patients (ages 1 day to 14 years). After clinical evaluation all patients were studied by echocardiography. Cardiac catheterization and ...

The associated features of 1-looping of the ventricles (ventricular inversion) with D-transposition of the great vessels and criss-crossing atrioventricular valves are an unusual constellation of cardiac anomalies resulting in corrected transposition physiology. The following case presentation depicts the fetal and postnatal considerations of two-dimensional and color Doppler echocardiography in accurately ...

To assess the pattern of aortic sinus in varied aortopulmonary rotations and its clinical implications, three aortic sinuses at the diastolic phase in true lateral view are identified in 53 angiograms of complete transposition of the great arteries recorded between 1988 and 1993. The patients with the high takeoff of ...

STUDY DESIGN: The present study describes anatomic observations on great medullary artery and intercostal arteries pertinent to thoracolumbar spinal surgery. OBJECTIVES: This study reveals the vulnerable course of the great medullary artery and its relationship to the lateral or posterolateral approach to thoracic spine. SUMMARY OF BACKGROUND DATA: There are ...

In 1824, Andrew F. Holmes, later to become the first Dean of the Medical Faculty of McGill University, published the autopsy findings of a 21-year-old man who had died with chronic cyanosis and congestive heart failure. Autopsy revealed the first documented case of single ventricle. Reinspection and detailed photographs published ...

A 10-year-old female child of the Jehovah's Witness faith presented with congenitally corrected transposition of the great arteries (S,L,L), pulmonary atresia, and a ventricular septal defect. A successful surgical correction was performed using an aortic homograft as a valved extracardiac conduit without the use of homologous blood or blood products. ...

The records of all children with simple (n = 73) and complex (n = 35) transposition of the great arteries who were born in western Sweden during 1964-83 were studied. The incidence was 0.24/1000 births. The preoperative mortality decreased from 100%, in 1964, before palliation was introduced, to 16% at ...

Isolation of the left innominate artery is a rare anomaly associated with a right aortic arch. Presented here is a case of a 3-day-old infant with an isolated innominate artery along with d-transposition of the great arteries, and a ductal-dependent circulation. These two lesions have not previously been reported together. ...

Coronary artery translocation is the most important step in achieving a successful result in arterial switch operations. Although a few centers have reported excellent results, coronary artery transfer requires a high technical expertise. We report a new technique of arterial switch operation without coronary translocation. By creating flaps in the ...

The complexity of the variability in aortic origin and epicardial course of the coronary arteries relative to the pedicles of the great arteries in hearts with transposition of the great arteries is evident in that there is no simple classification to include all the possible variations of the coronary artery ...

This study addresses the effects of early banding of the pulmonary trunk and subsequent management of subaortic obstruction on the attainment of acceptable pre-Fontan hemodynamics in patients with a single left ventricle and aorta arising from an outflow chamber. We report our experience with 26 patients seen at our institution ...

BACKGROUND: Current corrective surgical approaches for the Taussig-Bing heart include arterial switch with ventricular septal defect (VSD) closure and intraventricular repair as described by Kawashima. METHODS: Between 1983 and 1994, 20 children underwent intracardiac repair of Taussig-Bing anomaly. Mean age at operation was 17 months (range, 1 week to 9 ...

In a 19-year-old woman who had previously undergone pulmonary artery banding at the age of 1.5 years, a muscular right ventricular outflow tract obstruction developed 3 days after an arterial switch operation. Although conservative therapy proved successful, prophylactic surgical intervention on the conal septum may be beneficial in preventing the ...

We report the successful use of left subclavian artery bypass graft in a newborn infant with complete transposition of the great arteries accompanied by an unusual coronary artery pattern, in whom left coronary artery insufficiency developed after the arterial switch operation. This procedure has shown good clinical results, with interesting ...

An arterial switch operation was used only for a hyperdynamic transposition of the great arteries beyond the neonatal period at this hospital until the end of 1989. A 20-day-old baby girl underwent an arterial switch operation on March 3 1992 under the impression of simple transposition of the great arteries. ...

Arrhythmias are common problems following Mustard's operation for D-transposition of the great arteries. A 19-year-old male is presented who was diagnosed at birth with D-transposition of the great arteries and a right aortic arch and underwent a Mustard procedure at 12 months of age. He developed sinus node dysfunction and ...

BACKGROUND: The major morphologic change associated with retinoic acid (RA)-induced complete transposition of the great arteries (TGA), a congenital malformation of the heart, was investigated in a mouse model in which TGA was found in 80% of surviving fetuses. METHODS: Corrosion casts of embryonic hearts with or without prior exposure ...

Pathological examination of trisomic fetuses with increased nuchal translucency thickness at 11-13 weeks of gestation demonstrated a high prevalence of cardiac defects and abnormalities of the great arteries. This study reports the pathological findings observed from the examination of the heart and great arteries of 21 chromosomally normal fetuses with ...

Postoperative results of surgical repair of complete transposition of the great arteries (TGA) with pulmonary hypertension (PH) in 19 patients in whom mean pulmonary arterial pressure was >50 mmHg or the pulmonary/systemic arterial pressure ratio was >0.8 were examined. TGA with intact ventricular septum was diagnosed in 10 patients and ...

The surgical management of patients with double-outlet right ventricle or transposition of the great arteries and straddling atrioventricular valves remains a subject of controversy. Biventricular repair has theoretic advantages because it establishes normal anatomy and physiology. In some instances, however, it seems to carry too high operative risk, and a ...

BACKGROUND: Pulmonary hypertension due to persistent fetal circulation is rarely associated with transposition of the great arteries and intact ventricular septum. Previous attempts at management of affected neonates using prostaglandin E1 and balloon atrial septotomy followed by surgical repair have been largely unsuccessful. METHODS: Between September 1992 and April 1995, ...

A young child with [S, L, L] segmental anatomy, double-inlet left ventricle, transposition of the great arteries, rudimentary right ventricle, and mildly restrictive bulboventricular foramen is reported, in whom intraoperative temporary snaring of the modified Blalock-Taussig shunt resulted in instantaneous and dramatic volume contraction of the left ventricle, decrease in ...

A 61-year-old woman with levo-transposition of the great arteries, double-inlet single left ventricle, and valvar and subvalvar pulmonary stenosis presented with a large pulmonary valve vegetation unresponsive to antibiotic therapy. The diagnostic evaluation and the surgical management are discussed. At operation the pulmonary valve was excised and an abscess cavity ...

Double-outlet ventricle (DORV) is generally regarded as a congenital heart defect resulting from impaired morphogenesis of either the outflow portion (conotruncus) or the conoventricular flange (crista prima) of the embryonic heart. However, we demonstrate in this study chicken fetal hearts with DORV in which the conotruncal derivatives (great arteries and ...