Persistent neo-aortic root dilatation and aortic valve insufficiency after arterial switch operation following prior pulmonary artery banding.

Abstract

Although there have been great improvements in the short- and medium-term outcomes of the arterial switch operation (ASO) for transposition of the great arteries (TGA), some complications including pulmonary artery stenosis, aortic valve insufficiency, and aortic root dilatation have also been reported. After ASO, the original pulmonary root and valve, which function in the systemic position as the neo-aortic root and valve respectively, are exposed to the systemic blood pressure, resulting in aortic root dilatation and valve insufficiency in some patients. One of the risk factors for these complications is a history of prior pulmonary artery banding (PAB). Complex TGA anatomy, including transposition of the great arteries and ventricular septal defect (TGA-VSD) or double outlet right ventricle and ventricular septal defect (DORV-VSD), is also an independent risk factor for neo-aortic dilatation and aortic valve regurgitation. Aortic valve and root replacement is sometime necessary for the patients with these pathologies long-term after ASO. Here, we present a patient who had persistent aortic sinus dilatation and aortic valve insufficiency since ASO and necessitating aortic root and valve replacement 15 years after ASO preceded by PAB. The patient underwent Bentall operation and his clinical course was favorable. Histological findings after root replacement revealed no remarkable structural difference between neo-aortic wall (originally pulmonary artery) and original aortic wall.