Dextro-transposition of the great arteries rastelli operation

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]; Keri Shafer, M.D. [4]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [5]

Overview

Done for patients with TGA, VSD, and pulmonary outflow tract obstruction.
It depends on appropriate VSD anatomy (large and subaortic) because then it will be used as part of the left ventricular outflow tract (LVOT), involving placement of a baffle within the RV to direct blood flow from the VSD to the aorta. A conduit is inserted between the RV and the pulmonary artery, which is stitched.
Advantage- Left Ventricle becomes the systemic ventricle
Disadvantage- The conduit will likely need to be replaced several times during the patient’s life.
The appropriate age for this operation is still debated, due to the higher risk with the early repair.
The younger the patient the smaller the conduit, needing earlier reoperation.

(ACC/AHA) Recommendation for Diagnostic Catheterization for Adults With Repaired Dextro-Transposition of the Great Arteries^[1](DONOT EDIT)

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For adults with d-TGA, ventricular septal defect (VSD), and pulmonary stenosis (PS), after Rastelli-type repair, diagnostic catheterization can be beneficial to assist in the following:

1. Coronary artery delineation before any intervention for right ventricular outflow tract (RVOT) obstruction. (Level of Evidence: C) 2. Assessment of residual VSD. (Level of Evidence: C) 3. Assessment of PAH, with potential for vasodilator testing. (Level of Evidence: C) 4. Assessment of subaortic obstruction across the left ventricle-to-aorta tunnel. (Level of Evidence: C)

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(ACC/AHA) Recommendation for Interventional Catheterization for Adults with Repaired Dextro-Transposition of the Great Arteries^[1](DONOT EDIT)

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1. For adults with d-TGA, VSD, and PS, after Rastelli-type repair, interventional catheterization can be beneficial to assist in the following:

1. Dilation with or without stent implantation of conduit obstruction (RV pressure greater than 50% of systemic levels, or peak-to-peak gradient greater than 30 mm Hg; these indications may be lessened in the setting of RV dysfunction). (Level of Evidence: C)

2. Device closure of residual VSD. (Level of Evidence: C)

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For ACC/AHA Level of evidence and classes click:ACC AHA Guidelines Classification Scheme

References

↑ ^1.0 ^1.1 Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). “ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons”. J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.

Acknowledgements and Initial Contributors to Page

Leida Perez, M.D.

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[pmid19038677-1] 1.0 ^1.1 Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). “ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons”. J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.

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