En Bloc Rotation of the Outflow Tracts: An Option for Anatomic Repair of Complex Transposition

En bloc rotation of the outflow tracts offers a complete anatomic repair of complex transposition of the great arteries, with growth potential in all tubular structures and the option of preserving the native pulmonary valve in appropriate cases. It was first published by Dr Yamagishi and colleagues (2003) under the name “half-turn truncal switch procedure.” Other synonymous names are “double root translocation” and “en bloc rotation of the truncus arteriosus.” The term “en bloc rotation of the outflow tracts” was suggested by Dr Anderson (2016) to describe the procedure accurately.

Operative Technique

• The aorta and pulmonary artery were cut at the same level.
• Both coronary arteries were excised and mobilized.
• The truncus (conus) arteriosus was excised en bloc.
• The residual conus septum was divided, preserving the papillary muscle of the conus.
• The truncus (conus) arteriosus was rotated 180° and reimplanted.
• The ventricular septal defect (VSD) was closed and the left ventricular outflow tract (LVOT) enlarged.
• The coronary arteries were reimplanted.
• A LeCompte maneuver was performed.
• The aortic root and ascending aorta were anastomosed with an end-to-end anastomosis.
• The anastomosis between the pulmonary root and the right ventricular outflow tract (RVOT) was completed. If necessary a subvalvular patch plasty or transannular patch should be used, as shown in this video.
• The end-to-end anastomosis between the pulmonary root and the main pulmonary artery (PA) was completed.

Acknowledgment

The authors thank Dr Ulrike Mair-Berbalk for producing the video.

References

1. Anderson RH. Rotation of the ventricular outflow tracts. Eur J Cardiothorac Surg. 2016;50(3):585.
2. Mair R, Sames-Dolzer E, Vondrys D, Lechner E, Tulzer G. En bloc rotation of the truncus arteriosus-an option for anatomic repair of transposition of the great arteries, ventricular septal defect, and left ventricular outflow tract obstruction. J Thorac Cardiovasc Surg. 2006;131(3):740-741.
3. Mair R, Sames-Dolzer E, Innerhuber M, Tulzer A, Grohmann E, Tulzer G. Anatomic repair of complex transposition with en bloc rotation of the truncus arteriosus: 10-year experience. Eur J Cardiothorac Surg. 2016;49(1):176-182.
4. Yamagishi M, Shuntoh K, Matsushita T, et al. Half-turned truncal switch operation for complete transposition of the great arteries with ventricular septal defect and pulmonary stenosis. J Thorac Cardiovasc Surg. 2003;125(4):966-968.