Long-Term Follow-Up of the Conal Flap Method for Tricuspid Malinsertion in Transposition of the Great Arteries With Ventricular Septal Defect and Pulmonary.

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Long-Term Follow-Up of the Conal Flap Method for Tricuspid Malinsertion in Transposition of the Great Arteries With Ventricular Septal Defect and Pulmonary Stenosis Tai Fuchigami, MD, Mitsugi Nagashima, MD, PhD, Takeshi Hiramatsu, MD, PhD, Goki Matsumura, MD, PhD, Minori Tateishi, MD, Kenji Yamazaki, MD, PhD The Annals of Thoracic Surgery Volume 102, Issue 1, Pages 186-191 (July 2016) DOI: 10.1016/j.athoracsur.2016.01.055 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Conal flap (CF) method. (A) Tricuspid valve (TV) malinsertion into the infundibular septum is shown in a cross-sectional view of the RV. The infundibular septal flap, including the TV chordae, was created by making a reversed L-shaped incision from the anterior side to the subaortic portion of the infundibular septum. (B) The intracardiac rerouting patch is shown sutured at the left ventricular side of this flap, and the flap was reattached onto the right ventricular side of the patch. (C) A cross-sectional view of the left ventricle (LV)–ascending aorta (AAo) route. The infundibular septum was sifted to the right ventricular side, and this contributes a large and straight route from the LV to the AAo. (D) and (E) Variation of the CF. A reversed L-shaped incision was made to a pedicled flap of the septum including the medial papillary muscle. (PA = pulmonary artery; Patch = intracardiac rerouting patch; RA = right atrium; VSD = ventricular septal defect.) The Annals of Thoracic Surgery 2016 102, 186-191DOI: (10.1016/j.athoracsur.2016.01.055) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Estimated Kaplan-Meier survival curve. (A) Freedom from death. (B) Freedom from death or reoperation. The dotted line is the 95% confidence interval range. The Annals of Thoracic Surgery 2016 102, 186-191DOI: (10.1016/j.athoracsur.2016.01.055) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Postoperative evaluation by echocardiography at long-term follow-up. (A) Maximum flow velocity at left ventricular outflow tract. (B) Ratio of right ventricular (RV) pressure to left ventricular (LV) pressure. The Annals of Thoracic Surgery 2016 102, 186-191DOI: (10.1016/j.athoracsur.2016.01.055) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Postoperative tricuspid valve regurgitation at long-term follow-up. Number of patients. The Annals of Thoracic Surgery 2016 102, 186-191DOI: (10.1016/j.athoracsur.2016.01.055) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Postoperative activities of daily life at long-term follow-up. (A) New York Heart Association (NYHA) functional class. (B) Current lifestyle. The Annals of Thoracic Surgery 2016 102, 186-191DOI: (10.1016/j.athoracsur.2016.01.055) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions