Dextro-transposition of the great arteries rastelli operation


 * Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [mailto:psingh@perfuse.org]; ; Keri Shafer, M.D. [mailto:kshafer@bidmc.harvard.edu]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [mailto:kfeeney@perfuse.org]

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 (DONOT EDIT)==

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)

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

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)

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

Acknowledgements and Initial Contributors to Page
Leida Perez, M.D.