Sunday, April 24, 2011

The Jatene Procedure: Basics

The Jatene, or arterial switch, procedure corrects D-transposition of the great vessels. Patients usually first receive palliative treatment with prostaglandin E1 and balloon atrial septostomy (Rashkind procedure). The Jatene procedure is then performed in the first month of life

The Jatene procedure involves switching the main pulmonary artery (MPA) and the aorta (Ao) and relocating the ostia of the coronary arteries (RCA and LCA) to the new aorta. The Lecompte procedure is also performed, whereby the main pulmonary artery bifurcation is placed anterior to the ascending aorta. Axial images show the aorta posterior to the main pulmonary artery and between the right and the left pulmonary arteries (RPA and LPA, respectively). Dense contrast is seen in the left brachiocephalic vein (LBCV) on the coronal curved reformatted image.

Complications to watch for include:
  • Left ventricular impairment: Early.
  • Coronary artery issues: Early. Stenosis or occlusion.
  • Supravalvular pulmonary artery stenosis: Most frequent midterm complication. Most commonly occurs at the site of the anastomosis between the former aorta, any interposed graft (used to lengthen the main pulmonary artery), and the main pulmonary artery. Our patient had supravalvular stenosis and underwent pericardial patch augmentation of the main pulmonary artery (not clearly visible on CT).
  • Right or left pulmonary artery stenosis: Tend to occur after a Lecompte procedure, possibly due to stretching of these arteries after extensive dissection. Our patient had narrowing of the right pulmonary artery, which was subsequently stented.


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