Bicuspidization of Insufficient Neoaortic Valve After Arterial Switch With Looping Coronary Anatomy

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Neoaortic valve insufficiency after arterial switch operation (n=1). Intervention: Neoaortic valve bicuspidization. Primary outcome: Neoaortic valve function (insufficiency and stenosis).

Q: What does this research mean for the field?

Bicuspidization repair of an insufficient neoaortic valve achieves successful valve competence without stenosis in patients with looping coronary anatomy after an arterial switch operation. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Megan L. Schultz; Glen S. Van Arsdell; Ming‐Sing Si

doi:10.1016/j.atssr.2023.03.005

March 25, 2023Annals of Thoracic Surgery Short ReportsOpen Access

Bicuspidization of Insufficient Neoaortic Valve After Arterial Switch With Looping Coronary Anatomy

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Key result

Neoaortic valve bicuspidization successfully resolves pediatric neoaortic insufficiency with durable competence at 10 months.

n=1

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Why the study?

Neoaortic root dilation after arterial switch operation often leads to neoaortic valve insufficiency requiring reoperation, with limited data on bicuspidization repair techniques.

Does neoaortic valve bicuspidization improve neoaortic insufficiency in a pediatric patient with dextro-transposition of the great arteries and looping coronary anatomy after an arterial switch operation?

Key Points

To describe a surgical bicuspidization repair technique for severe neoaortic valve insufficiency in a pediatric patient with atypical looping coronary anatomy following neonatal arterial switch operation.
Evaluated a 5-year-old boy presenting with moderate neoaortic insufficiency, dilated left ventricle, and a 1L 2RCx coronary pattern after prior neonatal arterial switch operation and cusp repair.
Mobilized the circumflex coronary artery off the neoaortic root, harvested a right coronary artery button, excised the nonviable replacement leaflet and sinus, and reconstructed the valve into a bicuspid configuration with reimplantation of the right coronary artery.
Immediate postoperative echocardiography showed trace neoaortic insufficiency without stenosis, generous coaptation height, good biventricular function, and patent right coronary artery flow, allowing discharge on postoperative day 3.
At 10 months postoperatively, echocardiography demonstrated trivial neoaortic valve insufficiency with two small regurgitant jets, no neoaortic stenosis, normal left ventricular size, and excellent biventricular function.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does neoaortic valve bicuspidization improve neoaortic insufficiency in a pediatric patient with dextro-transposition of the great arteries and looping coronary anatomy after an arterial switch operation?

P

Population

A 5-year-old boy with dextro-transposition of the great arteries and neoaortic insufficiency after a neonatal arterial switch operation, followed for 10 months.

I

Intervention

Neoaortic valve bicuspidization repair technique (excision of replacement right anterior leaflet and sinus, creation of new commissural post, and reimplantation of RCA button).

O

Outcome

Echocardiographic assessment of neoaortic valve function and ventricular size at 10 months postoperatively.surrogate

Neoaortic valve bicuspidization using native tissue is a feasible repair technique that preserves growth potential for treating neoaortic insufficiency after an arterial switch operation in children with looping coronary anatomy.

Limitations

Short-term follow-up requires continued assessment for long-term durability
Single patient case report limits generalizability
Short-term follow-up
Single patient case report

Implication

Suggests feasibility of neoaortic valve bicuspidization in children; leaves open durability and broader applicability.

Abstract

Neoaortic root dilation is inevitable in the years after an arterial switch operation, not uncommonly leading to neoaortic valve insufficiency that requires reoperation. Here we present a bicuspidization repair technique for addressing such neoaortic valve insufficiency in a child with the 1L 2RCx coronary pattern who underwent the arterial switch operation as a neonate for dextro-transposition of the great arteries that has good short-term outcomes thus far.

Discussion

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Cite This Study

Schultz et al. (2023) conducted a case report in Neoaortic valve insufficiency after arterial switch operation (n=1). Neoaortic valve bicuspidization was evaluated on Neoaortic valve function (insufficiency and stenosis). Neoaortic valve bicuspidization successfully treated neoaortic insufficiency in a 5-year-old boy, resulting in trivial insufficiency and no stenosis at 10 months postoperatively.

synapsesocial.com/papers/6abdf8b736276ab04c6e1b9e https://doi.org/10.1016/j.atssr.2023.03.005

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Bicuspidization of Insufficient Neoaortic Valve After Arterial Switch With Looping Coronary Anatomy

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Bicuspidization of Insufficient Neoaortic Valve After Arterial Switch With Looping Coronary Anatomy

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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