Senning repair for transposition of the great arteries without patch augmentation of the septum.

Forty-three consecutive patients with previous balloon atrial septostomy have undergone a Senning type repair of transposition of the great arteries without patch augmentation of the atrial septum. A technique was used that allows expansion of the atrial septum without the use of additional foreign or autogenous materials. The operative (30-day) mortality rate was 4.6% (2/43) with no late deaths. A mean follow-up of 20 months shows that 83% of the patients are in sinus rhythm and none of these patients have clinically detectable caval or pulmonary venous obstruction or baffle leaks. In patients selected for atrial switch, the Senning operation may be performed without patch augmentation of the septum. Performed by the method described herein, the operation provides predictable early and late results with a low prevalence of arrhythmias. Significant venous obstruction has not occurred.

Prosthetic valve replacement using annular preservation technique.

Preservation of as much annulus as possible is an extremely important aspect of prosthetic valve replacement. A method is described that allows intact removal of a prosthetic valve without damage to the annulus. This simple technique has been used regularly for three years, and there have been no complications.

Concomitant repair of aortopulmonary window and interrupted aortic arch.

Aortopulmonary window with type A interrupted aortic arch was diagnosed in 2 critically ill neonates. Echocardiographic diagnostic methods provided precise anatomic information, which allowed cardiac catheterization to be avoided before operation. Repair was undertaken through a midline sternotomy using hypothermic, low-flow cardiopulmonary bypass with subclavian turn-down in one patient and hypothermic circulatory arrest with direct aortoaortic anastomosis in the other. Both methods provided good exposure and allowed favorable anatomic repair.

Intravalvular implantation of mitral valve prostheses.

We describe a technique of intravalvular implantation of a low-profile prosthesis that has been used in nine patients with mitral valve lesions. This technique preserves the anterior and posterior chordae and papillary mechanisms, which may decrease the incidence of postoperative left ventricular dysfunction that has been noted following standard mitral valve replacement. The technique may also be useful in some patients with aortic and tricuspid regurgitation when the annulus and leaflets are relatively normal pathologically.