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Interact Cardiovasc Thorac Surg. 2016 Jun;22(6):817-25. doi: 10.1093/icvts/ivw014. Epub 2016 Feb 25.

Is the Lecompte technique the last word on transposition of the great arteries repair for all patients? A magnetic resonance imaging study including a spiral technique two decades postoperatively.

Author information

1
Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany carsten.rickers@uksh.de.
2
University of California Irvine, Edwards Lifesciences Center of Advanced Cardiovascular Technology, Irvine, CA, USA.
3
Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
4
Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
5
Department of Radiology, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA.

Abstract

OBJECTIVES:

To compare the Lecompte technique and the spiral anastomosis (complete anatomic correction) two decades after arterial switch operation (ASO).

METHODS:

Nine patients after primary ASO with Lecompte and 6 selected patients after spiral anastomosis were evaluated 20.8 ± 2.1 years after ASO versus matched controls. Blood flow dynamics and flow profiles (e.g. vorticity, helicity) in the great arteries were quantified from time-resolved 3D magnetic resonance imaging (MRI) phase contrast flow measurements (4D flow MR) in addition to a comprehensive anatomical and functional cardiovascular MRI analysis.

RESULTS:

Compared with spiral reconstruction, patients with Lecompte showed more vortex formation, supranatural helical blood flow (relative helicity in aorta: 0.036 vs 0.089; P < 0.01), a reduced indexed cross-sectional area of the left pulmonary artery (155 vs 85 mm²/m²; P < 0.001) and more semilunar valve dysfunctions (n = 5 vs 1). There was no difference in elastic aortic wall properties, ventricular function, myocardial perfusion and myocardial fibrosis between the two groups. Cross-sectional area of the aortic sinus was larger in patients than in controls (669 vs 411 mm²/m²; P < 0.01). In the spiral group, the pulmonary root was rotated after ASO more towards the normal left position (P < 0.01).

CONCLUSIONS:

In this study, selected patients with spiral anastomoses showed, two decades after ASO, better physiologically adapted blood flow dynamics, and attained a closer to normal anatomical position of their great arteries, as well as less valve dysfunction. Considering the limitations related to the small number of patients and the novel MRI imaging techniques, these data may provoke reconsidering the optimal surgical approaches to transposition of the great arteries repair.

KEYWORDS:

Lecompte technique; Magnetic resonance imaging; Physiological spiral anastomosis; Transposition of great vessels

PMID:
26920722
PMCID:
PMC4986772
DOI:
10.1093/icvts/ivw014
[Indexed for MEDLINE]
Free PMC Article

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