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Effects of surgical en bloc rotation of the arterial trunk on the conduction system in children with transposition of the great arteries, ventricular septal defect and pulmonary stenosis

Published online by Cambridge University Press:  14 July 2015

Christoph Prandstetter ,
Andreas Tulzer ,
Rudolf Mair ,
Eva Sames-Dolzer  and
Gerald Tulzer
Christoph Prandstetter*
Affiliation:
Department of Pediatric Cardiology, Children’s Heart Center Linz, Linz, Austria
Andreas Tulzer
Affiliation:
Department of Pediatric Cardiology, Children’s Heart Center Linz, Linz, Austria
Rudolf Mair
Affiliation:
Department of Pediatric Cardiac Surgery, Children’s Heart Center Linz, Linz, Austria
Eva Sames-Dolzer
Affiliation:
Department of Pediatric Cardiac Surgery, Children’s Heart Center Linz, Linz, Austria
Gerald Tulzer
Affiliation:
Department of Pediatric Cardiology, Children’s Heart Center Linz, Linz, Austria
*
Correspondence to: C. Prandstetter, Department of Pediatric Cardiology, Children’s Heart Center Linz, Krankenhausstrasse 26-30, 4020 Linz, Austria. Tel: +0043 650 7715035; E-mail: cprandstetter@gmx.at
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Abstract

Objectives

The standard surgical management of patients with transposition of the great arteries, ventricular septal defect, and pulmonary stenosis is the Rastelli operation. Recently, en bloc rotation of the arterial trunk, by cutting out the aortic and the pulmonary root in one block and by rotating it 180°, has been introduced as a new option for anatomical repair.

Methods

To evaluate the effects of this surgical method on the conduction system, pre-operative, post-operative, and follow-up electrocardiograms as well as patient charts were reviewed retrospectively. A total of 16 consecutive patients with transposition of the great arteries and left outflow tract obstruction were treated with en bloc rotation.

Results

During the post-operative period, there were two patients with complete atrio-ventricular block, one with junctional ectopic tachycardia, one with ventricular tachycardia, and one with supraventricular tachycardia. None of the patients had a typical right bundle branch block pattern before surgery; however, this pattern was detectable after surgery in eight out of 16 patients (50%), which persisted during the follow-up. All patients without typical right bundle branch block pattern showed a median QRS duration of 65 ms (54–112 ms) before surgery, 62 ms (54–122 ms) after surgery, and 84 ms (66–128 ms) at the last follow-up visit. This compares well with a similar Rastelli cohort, where a right bundle branch block prevalence of 77% was reported. Out of 16 patients, 12 showed non-specific ST changes and negative T-waves, which persisted during follow-up with an unknown significance for the future.

Conclusion

Our data suggest that en bloc rotation of the arterial trunk seems not to have more negative effects on the conduction system than the Rastelli operation.

Keywords

En bloc rotation of the truncus arteriosustransposition of the great arteriespulmonary stenosisaortic root translocationleft ventricular outflow tract obstructionRastelli procedure
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 3 , March 2016 , pp. 516 - 520
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Copyright
© Cambridge University Press 2015 

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