Spiral arterial switch operation in transposition of the great arteries Ing-Sh Chiu, MD, PhD, MDiva, Jou-Kou Wang, MD, PhDb, Mei-Hwan Wu, MD, PhDb The.

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Spiral arterial switch operation in transposition of the great arteries Ing-Sh Chiu, MD, PhD, MDiva, Jou-Kou Wang, MD, PhDb, Mei-Hwan Wu, MD, PhDb The Journal of Thoracic and Cardiovascular Surgery Volume 124, Issue 5, Pages 1050-1052 (November 2002) DOI: 10.1067/mtc.2002.125204 Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Wu, Chiu, and Wang (left to right) The Journal of Thoracic and Cardiovascular Surgery 2002 124, 1050-1052DOI: (10.1067/mtc.2002.125204) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 1 Techniques of spiral arterial switch operation for single coronary artery. Semilunar valves are all omitted for clear illustration. A, Aorta is amputated obliquely. Left posterior wall of pulmonary trunk is not divided. Two J-shaped incisions are made on facing parts of great arteries. Anterior wall of pulmonary trunk is cut back along dashed line to accommodate ascending aorta. B, Anulus of facing commissure in old aorta is fixed to anterior wall of pulmonary trunk (depicted by Y stitches). Lateral edges of two J-shaped incisions facing each other are sutured together (depicted by X stitches) to form aortopulmonary window. Then semiflap of pulmonary trunk is placed into opposite aortic sinus and sutured so that it acts as posterior wall of neopulmonary trunk and as anterior wall of neoaorta. C, Suture for pulmonary trunk semiflap in sinus 2 (depicted by I stitches) is finished. Anterior lip of cut back pulmonary trunk is everted to left. Distal aorta is sutured to posterior wall of pulmonary trunk along dotted line. Aortic sinus 1 is cut back along dashed line. D, Neoaortic anastomosis is finished. Cut back edge of aortic sinus 1 is attached to anterior neoaortic root to augment pulmonary pathway. Cut edge of pulmonary trunk and caudal edge of right pulmonary artery are attached to posterior aorta from right. E, Cephalic cut edge of right pulmonary artery is attached to posterior outer wall of aorta from left. Caudal edge of anterior pulmonary trunk flap is attached to amputated edge of aortic sinus 1 to form floor of pulmonary pathway. F, Finally, attaching anterior pulmonary trunk flap to ascending aorta completes roofing of anterior pulmonary pathway. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 1050-1052DOI: (10.1067/mtc.2002.125204) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 2 Techniques of modified arterial switch operation with neopulmonary trunk in left anterior portion. Main difference from previously published figure1 is in part C. Cephalic edge of pulmonary semiflap is sutured to amputated edge of sinus 1 (depicted by heavy I stitches) instead of to inner wall of sinus 1 just to cover coronary sinus, thus less suture line is needed. Parts are as in Figure 1. The Journal of Thoracic and Cardiovascular Surgery 2002 124, 1050-1052DOI: (10.1067/mtc.2002.125204) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 3 Spiral relationship of great arteries in normal heart (C) was not restored by conventional arterial switch operation with Lecompte maneuver (B) on transposition of the great arteries (TGA; A). With spiral ASO (D), pulmonary bifurcation is free from posterior compression by high-pressure aorta. Note that acute angulation of arch that is present after nonspiral Lecompte maneuver (B) is absent in other three illustrations. Modified from Prêtre R, Tamisier D, Bonhoeffer P, Mauriat P, Pouard P, Sisi D, et al. Results of the arterial switch operation in neonates with transposed great arteries. Reprinted with permission from Elsevier Science (The Lancet, 2001;357:1826-30). The Journal of Thoracic and Cardiovascular Surgery 2002 124, 1050-1052DOI: (10.1067/mtc.2002.125204) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions