LeCompte maneuver

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The Lecompte maneuver is a technique used in open heart surgery, primarily on infants and children. The maneuver entails cutting the main pulmonary artery and moving it anterior to the aorta before reattaching the pulmonary artery during the following reconstruction of the great vessels. [1] [2] It allows the surgeon to reconstruct the right ventricular outflow tract without needing to connect the proximal and distal sections with a graft. [2] [3] It also enables the surgeon to avoid compressing the coronary arteries and relieves compression of the bronchi in cases where the pulmonary artery is severely dilated or aneurysmal. If both pulmonary arteries are not mobilized adequately, they can become stretched, leading to pulmonic stenosis. [2]

Commonly, the maneuver is used during an arterial switch procedure (in which the pulmonary artery and aorta switch positions) or in surgery to correct absent pulmonary valve syndrome. [1] [4] It is also used in corrective surgeries for Tetralogy of Fallot where the pulmonary valve is anomalous, persistent truncus arteriosus with aortopulmonary window that affects the aortic arch, left-to-right shunts, anomalous right pulmonary artery, and ALCAPA (anomalous left coronary artery from the pulmonary artery). Other surgeries that regularly employ the LeCompte maneuver include the Yasui procedure, REV procedure, and Nikaidoh operation, all of which are used to reconstruct hearts with an anomalous left ventricular outflow tract. [2]

The technique was first used in 1981 and described in 1982. [2] [3]

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The Yasui procedure is a pediatric heart operation used to bypass the left ventricular outflow tract (LVOT) that combines the aortic repair of the Norwood procedure and a shunt similar to that used in the Rastelli procedure in a single operation. It is used to repair defects that result in the physiology of hypoplastic left heart syndrome even though both ventricles are functioning normally. These defects are common in DiGeorge syndrome and include interrupted aortic arch and LVOT obstruction (IAA/LVOTO); aortic atresia-severe stenosis with ventricular septal defect (AA/VSD); and aortic atresia with interrupted aortic arch and aortopulmonary window. This procedure allows the surgeon to keep the left ventricle connected to the systemic circulation while using the pulmonary valve as its outflow valve, by connecting them through the ventricular septal defect. The Yasui procedure includes a modified Damus–Kaye–Stansel procedure to connect the aortic and pulmonary roots, allowing the coronary arteries to remain perfused. It was first described in 1987.

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References

  1. 1 2 "Arterial Switch Procedure for D-transposition of the great arteries". chw.org. Retrieved August 29, 2018.
  2. 1 2 3 4 5 Talwar, Sachin; Muthukkumaran, Subramanian; Choudhary, Shiv Kumar; Airan, Balram (April 2014). "The expanding indications for the Lecompte maneuver". World Journal for Pediatric & Congenital Heart Surgery. 5 (2): 291–296. doi:10.1177/2150135113508796. ISSN   2150-136X. PMID   24668977.
  3. 1 2 Lecompte, Y; Neveux, JY; Leca, F; Zannini, L; Tu, TV; Duboys, Y; Jarreau, MM (November 1982). "Reconstruction of the pulmonary outflow tract without prosthetic conduit". The Journal of Thoracic and Cardiovascular Surgery. 84 (5): 727–33. doi: 10.1016/s0022-5223(19)38962-7 . ISSN   0022-5223. PMID   7132411.
  4. Nölke, Lars; Azakie, Anthony; Anagnostopoulos, Petrous V.; Alphonso, Nelson; Karl, Tom R. (May 2006). "The Lecompte Maneuver for Relief of Airway Compression in Absent Pulmonary Valve Syndrome". The Annals of Thoracic Surgery. 81 (5): 1802–1807. doi:10.1016/j.athoracsur.2005.12.001. ISSN   0003-4975. PMID   16631676.