Surgical technique of the Bex-Nikaidoh operation for dextro-transposition of the great arteries with a ventricular septal defect and pulmonary stenosis using an 'oversized' conduit

We report a case of a 4-month-old infant with dextro (d)-transposition of the great arteries, ventricular septal defect (VSD) and left ventricular outflow tract obstruction previously palliated with a systemic-to-pulmonary shunt. He underwent repair by aortic root translocation with an arterial switch procedure and coronary artery reimplantation (modified Bex-Nikaidoh operation). This case demonstrates that aortic translocation results in a more normal anatomic repair compared with the Rastelli operation. As shown, it is always possible to place an oversized conduit (homograft) and there is no risk of sternal compression of the conduit. This is especially important for children under 1 year, when there are contraindications for the Rastelli operation. Placement of oversized pulmonary ventricle-pulmonary artery conduits is performed to decrease conduit failure in the future. The postoperative course was uneventful. At 6 months, he was asymptomatic with tomographic images and echocardiography showing no residual lesions.