Yasuharu Imai

Taussig-Bing Heart with Mitral Valve Straddling Case Reports and Postmortem Study

Seven autopsied cases of the Taussig-Bing Heart diagnosed at the Heart Institute of Japan were reexamined for this report. Three cases had been correctly classified according to the original description of the Taussig-Bing Heart. The remaining four cases provided examples of a rare variation of this malformation. Characteristic features included the following: the mitral valve straddled the ventricular septum in all cases; the chordae of the anterior leaflet crossed over the septum into the right ventricle through a large subpulmonary ventricular septal defect; and an abnormal muscle ridge, extending from the caudal part of the parietal band, covered the right ventricular side of the ventricular septal defect. Although these four cases differ anatomically from the original Taussig-Bing Heart, their hemodynamics are similar. We have called this anomaly the Taussig-Bing Heart with mitral valve straddling.

Balloon Angioplasty of Pulmonary Artery Following Arterial Switch Operation for Complete Transposition of the Great Arteries

Twenty-eight patients with transposition of the great arteries underwent 39 balloon angioplasty procedures after the arterial switch operation. The mean age at dilation was 4.5 years (range, 0.7–10 years). The mean interval between operation and balloon dilation was 3.6 years. The criterion of successful dilation was an increase of 50% or greater in the predilation diameter or a decrease of 50% or greater in the predilation pressure gradient. The success rate of balloon angioplasty for pulmonary artery stenosis was 51%. The interval between operation and dilation in the successful dilation group was significantly less than that in the unsuccessful dilation group. In 13 patients who underwent balloon angioplasty less than 3.5 years after operation, balloon dilation was successful in 92%. A balloon-to-artery ratio of more than 2.3 was necessary to dilate the stenotic segment. There were no deaths, but one pulmonary artery rupture, which did not require surgical intervention, occurred. Aneurysmal dilation of the pulmonary artery was observed in 3 patients. These data indicate that although the success rate of balloon angioplasty for pulmonary artery stenosis after the arterial switch operation is modest (50%), balloon angioplasty can be the first therapeutic choice owing to the low complication rate and the potential benefit of the procedure. The success rate can be high if angioplasty is performed less than 3.5 years after operation and a balloon of adequate size is used.

Total Correction of Double-Outlet Right Ventricle

Double-outlet right ventricle (DORV) has been defined by Lev et al. as a situation in which there are two ventricles and two great arteries, with all of one great vessel and more than half of the second great artery arising from the right ventricle. For the simpler types of DORV with subaortic ventricular septal defect (VSD), in which the aorta overrides the ventricular septum, only cases with the mitral-aortic fibrous discontinuity are included in this category. Also, cases either with atrioventricular (AV) inversion with two great arteries arising from the anatomic right ventricle or with pulmonary atresia are classified as DORV.