Aortic translocation for the management of double-outlet right ventricle and pulmonary stenosis with dextrocardia: technique to avoid coronary insufficiency

Abstract

The management of D-loop transposition of the great arteries with left ventricular outflow tract obstruction and related forms of double-outlet right ventricle is challenging. Association with right ventricular and tricuspid valve hypoplasia and dextrocardia represents a major obstacle to achieve a biventricular repair. The most commonly used technique to deal with this condition, which is the Rastelli operation, further reduces the potentially compromised right ventricular volume due to the left ventricle-to-aorta baffle. Because the Rastelli operation risks later development of left ventricular outflow tract obstruction, aortic translocation can be considered for these patients. We report a case of double-outlet right ventricle with left ventricular outflow tract obstruction in the setting of dextrocardia, left juxtaposition of the atrial appendages, and a small tricuspid valve, which was successfully managed with a biventricular repair by means of an aortic translocation technique.