Rastelli procedure

Rastelli procedure

Abstract: Rastelli procedure is done in cases of D-Transposition of great arteries with left ventricular outflow tract obstruction and ventricular septal defect, when arterial switch is not feasible.

Rastelli procedure is done in case of D-Transposition of great arteries (D-TGA) with ventricular septal defect and left ventricular outflow obstruction as arterial switch is not feasible. It was described by G C Rastelli in 1969 [1]. The ventricular septal defect is widened and the infundibular septum resected, followed by baffling of the left ventricle to the aorta [2].

In the series of forty patients reported by Brown JW, Ruzmetov M, Huynh D, Rodefeld MD, Turrentine MW and Fiore AC [3], the right ventricular outflow tract was reconstructed using homograft in twenty five, bovine jugular vein in eight, non valved Dacron tube in five and a porcine valved conduit in two cases. In their series, there were three late deaths and one patient underwent cardiac transplantation after twelve years. In general, the procedure is considered as a low risk procedure with regard to mortality and reoperation for left ventricular outflow tract obstruction. But conduit replacement will be needed in most and can be done with reasonable morbidity and mortality.

Straddling tissue from tricuspid valve across the left ventricular outflow tract makes Rastelli procedure difficult requiring a modification of the procedure.

Late problems after Rastelli procedure

Important problems which can occur later in life after Rastelli procedure are recurrence of left ventricular outflow tract obstruction, conduit obstruction and cardiac arrhythmias including complete heart block requiring the implantation of a permanent pacemaker.

References

1. G C Rastelli. A new approach to “anatomic” repair of transposition of the great arteries. Mayo Clin Proc. 1969 Jan;44(1):1-12.
2. Alsoufi B, Awan A, Al-Omrani A, Al-Ahmadi M, Canver CC, Bulbul Z, Kalloghlian A, Al-Halees Z. The rastelli procedure for transposition of the great arteries: resection of the infundibular septum diminishes recurrent left ventricular outflow tract obstruction risk. Ann Thorac Surg. 2009 Jul;88(1):137-42.
3. Brown JW, Ruzmetov M, Huynh D, Rodefeld MD, Turrentine MW, Fiore AC. Rastelli operation for transposition of the great arteries with ventricular septal defect and pulmonary stenosis. Ann Thorac Surg. 2011 Jan;91(1):188-93.