Some Special Circumstances

It is after much deliberation that I decided to add this section. It is not essential, and if you don't understand it, skip it !

TGA after 2 months of age - the Rapid Two-Stage ASO

When a child with TGA comes for treatment only after 4 to 8 weeks, the left ventricle is too weak to support the circulation after an ASO. To prepare the left ventricle, an initial operation called "banding" is done. A tape or thread is placed around the artery arising from the left ventricle (i.e. pulmonary artery in TGA) to constrict it and make it narrow. The left ventricle is thus "trained" to work against the higher resistance produced by this narrow outflow and becomes stronger and thick walled. Within two weeks, an ASO is then performed with a better outcome, since the left ventricle is now capable of handling its workload of pumping blood to the entire body. This is called the rapid two-stage ASO and was devised by Dr.Aldo Castaneda.

TGA with a narrow pulmonary valve - Alternate Operations.

After an ASO, the pulmonary valve is now shifted to the left ventricle, a region of higher pressures than the right. If the pulmonary valve is narrow or abnormal, it cannot function normally in the high pressure area. So other procedures have been devised for these patients.

• RASTELLI procedure
  In this operation, the pulmonary valve is surgically closed. A tube or conduit in which a valve is placed, is used to connect the right ventricle to the pulmonary artery. This avoids including the abnormal pulmonary valve in the circulation. One disadvantage with this operation is that in very small children, a second operation will be needed to replace the conduit as the child outgrows it.
• LECOMPTE (or REV) procedure
  This is similar to the Rastelli operation, but aims to avoid the complications related to using a conduit. The pulmonary artery is moved close to the right ventricle, and sewn to it DIRECTLY, using a patch of pericardium to widen the junction.
• NIKAIDOH procedure
  In this operation, the aorta is "switched" ALONG WITH THE AORTIC VALVE and placed in the pulmonary position. This avoids leak of a faulty pulmonary valve on the left side.

If there's anything more you want to read about, or some areas which aren't clear enough, don't hesitate to write and let me know.

 

---

home	|	disease	|	webcast	|	latest	|	links
news	|	archive	|	contact	|	books	|	disclaimer

 

Member of the Internet Link Exchange

Conceived, created and designed by Dr.S.Sivasubramanian. Copyright 1998, All rights reserved.