Complex Transposition of the Great Arteries with Interrupted Aortic Arch: Modified Great Vessel Reconstruction

Abstract

Transposition of the great arteries with ventricular septal defect is often associated with anterior malalignment of the conal septum, hypoplasia of the ascending aorta and aortic arch, interrupted aortic arch or coarctation of the aorta, and hyperplasia of the main pulmonary artery. This marked disparity in great vessel size can result in difficulties at and beyond the neo-aorta-to-ascending aorta suture line, such as bleeding, distortion, obstruction, or the use of nonviable patch material. A modified surgical approach is presented in which the ascending aorta is anastomosed to the descending aorta, followed by anastomosis of the neo-aorta to the underside of the newly constructed aortic arch using a native aortic flap. The proposed technique greatly simplifies the reconstruction of the neo-aorta and the interrupted aortic arch, reduces tension on the neo-aorta to neo-aortic arch anastomosis, and preserves growth potential of the latter. This modification can especially be of benefit after radical resection of ductal tissue, particularly in association with interrupted aortic arch type A, with resulting long distance between the ascending and descending aorta.