PubMed · 2918744
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R H Anderson. 1989. Double-outlet ventriculoarterial connection.. https://pubmed.ncbi.nlm.nih.gov/2918744/
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A 60 year-old male presented with abnormal systolic heart murmur. Transthoracic echocardiogram revealed right ventricular (RV) hypertrophy and mosaic jet in the RV outflow tract. RV catheterization revealed significantly pressure gradient between the RV and the pulmonary artery. Enhance ECG-gated multislice CT was performed and an axial source image in end-diastole revealed RV myocardial hypertrophy and remarkable hypertrophy of the moderator band. Multiplanar reconstruction images in end-systole revealed hypertrophic anomalous muscle bundles in the RV and significant narrowing of the RV outflow tracts and a post-stenotic dilated pulmonary trunk. In volume rendered images, in end-systole, the lumen of RV outflow tract revealed severe stenosis compared with that in end-diastole and he was diagnosed with double chamber RV.
Anterior translocation of the pulmonary root was used as a new approach to the staged repair of Taussig-Bing anomaly with an interrupted aortic arch. It was performed to construct the right ventricle outflow tract with intraventricular baffling of the left ventricle to the aorta as the second stage operation after repair of the interrupted arch and pulmonary artery banding. This technique allows minimization of pulmonary regurgitation and has the major theoretical advantage for growth potential, which could diminish the need for reoperation.
BACKGROUND: This study evaluates the results of the arterial switch operation for early total repair of double-outlet right ventricle with subpulmonary ventricular septal defect (the Taussig-Bing heart). METHODS: From 1986 through April 2003, 27 patients with Taussig-Bing anomaly underwent arterial switch operation. Twenty patients were neonates (n = 11) or infants younger than 3 months (n = 9). Obstruction of aortic arch (n = 19) or subaortic right ventricular outflow tract obstruction (n = 20) and unusual coronary artery patterns (n = 19) were common. Total correction as a single procedure was performed in 21 patients. Events are depicted by Kaplan-Meier curves. RESULTS: There was 1 patient hospital death at 2 months after repair. One patient died late that was not cardiac related. Survival was 92% +/- 6% at 8 months and remained constant thereafter. Four patients underwent reoperation (1 for residual aortic arch obstruction and 3 for subvalvular and valvular pulmonary stenosis). Freedom from reoperation decreased to stabilize at 83% +/- 8% after 2 years. The risk to have right ventricular outflow tract obstruction develop was 33% +/- 10% at 1 year, increasing slowly and leveling out at 57% +/- 12% at year 5 and thereafter. Statistical analysis revealed no significant risk factor for death or need for reoperation. CONCLUSIONS: The Taussig-Bing anomaly should be corrected in the neonatal period or in early infancy by arterial switch operation, closure of the ventricular septal defect, and simultaneous correction of associated cardiovascular anomalies as a one-stage procedure. Right ventricular outflow tract obstruction often complicates the postoperative course and is the main cause for reintervention.