Total thoracoscopic approach for morphologic tricuspid valve replacement in congenitally corrected transposition of great arteries: The first case report in China_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GE Tongkai ^1,2 , ZHANG Chaolong ^1,2 ,  ZHAO Junfei ^1,2 , LUO Dandong ^1,2 ,  HUANG Huanlei ^1,2

1. Department of Cardiac Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, P. R. China;
2. Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academic of Medical Science), Guangzhou 510080, P. R. China;

Corresponding author：

ZHAO Junfei, Email: zhaojunfei@gdph.org.cn; HUANG Huanlei, Email: hhuanglei@hotmail.com

Keywords：

Congenitally corrected transposition of the great arteries (ccTGA); morphologic tricuspid regurgitation; totally thoracoscopic; valve replacement surgery

DOI：

10.7507/1007-4848.202502074

Video：

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A 23-year-old male patient was diagnosed with congenitally corrected transposition of the great arteries (ccTGA) at the age of 3 during a routine physical examination. Due to the absence of significant symptoms, the patient was managed conservatively with follow-up without surgical treatment. He developed chest tightness one year prior to admission, with symptom exacerbation in the recent month. Echocardiography demonstrated significantly worsened morphological tricuspid regurgitation. The patient presented to Guangdong Provincial People’s Hospital for surgical evaluation. Given the patient’s age and clinical presentation, a totally thoracoscopic morphological tricuspid valve replacement was performed. Postoperative assessment showed good prosthetic valve function, with no regurgitation or paravalvular leakage; the electrocardiogram confirmed sinus rhythm without atrioventricular block. Extubation occurred within 12 hours postoperatively, and the patient was transferred from the intensive care unit (ICU) on postoperative day 2. At the three-month follow-up, the patient was asymptomatic and had resumed normal activities. This report describes the first case of a totally thoracoscopic morphological tricuspid valve replacement in a ccTGA patient in China. This initial experience suggests that the totally thoracoscopic approach for morphological tricuspid valve replacement in ccTGA patients is a feasible, safe, and effective minimally invasive option associated with rapid recovery.

1.	Graham TP, Bernard YD, Mellen BG, et al. Long-term outcome in congenitally corrected transposition of the great arteries: A multi-institutional study. J Am Coll Cardiol, 2000, 36(1): 255-261.
2.	Vejlstrup N, Sørensen K, Mattsson E, et al. Long-term outcome of mustard/senning correction for transposition of the great arteries in Sweden and Denmark. Circulation, 2015, 132(8): 633-638.
3.	Scherptong RW, Vliegen HW, Winter MM, et al. Tricuspid valve surgery in adults with a dysfunctional systemic right ventricle: Repair or replace? Circulation, 2009, 119: 1467-1472.
4.	Gupta S, McEwen C, Eqbal A, et al. Minimally invasive surgery for congenital heart disease. Ann Thorac Surg, 2023, 118(4): 953-962.
5.	Murtuza B, Barron DJ, Stumper O, et al. Anatomic repair for congenitally corrected transposition of the great arteries: A single-institution 19-year experience. J Thorac Cardiovasc Surg, 2011, 142(6): 1348-1357.
6.	Hornung TS, Calder L. Congenitally corrected transposition of the great arteries. Heart, 2010, 96(14): 1154-1161.
7.	李琦, 邓隆, 许建屏, 等. 三尖瓣置换术治疗成人先天性矫正性大动脉转位的远期临床结果及其危险因素分析. 中国胸心血管外科临床杂志, 2019, 26(9): 5.Li Q, Deng L, Xu JP, et al. Long-term outcome and risk factor analysis of tricuspid valve replacement for adult patients with congenitally corrected transposition of great arteries. Chin J Clin Thorac Cardiovasc Surg, 2019, 26(9): 5.
8.	Devaney EJ, Charpie JR, Ohye RG, et al. Combined arterial switch and Senning operation for congenitally corrected transposition of the great arteries: patient selection and intermediate results. J Thorac Cardiovasc Surg, 2003, 125: 500-507.
9.	王新桥, 黄方炯. 矫正型大动脉转位形态三尖瓣置换术一例. 心血管外科杂志(电子版), 2015, 4(4): 198-199 .Wang XQ, Huang TF. A case of tricuspid valve replacement in corrected transposition of the great arteries. Chin J Vasc Surg(Electronic Version), 2015, 4(4): 198-199.
10.	Said SM, Dearani JA, Burkhart HM, et al. Management of tricuspid regurgitation in congenital heart disease: Is survival better with valve repair? J Thorac Cardiovasc Surg, 2014, 147(1): 412-417.
11.	Koolbergen DR, Ahmed Y, Bouma BJ, et al. Follow-up after tricuspid valve surgery in adult patients with systemic right ventricles. Eur J Cardiothorac Surg, 2016, 50: 456-463.
12.	罗国华, 胡盛寿, 孙寒松, 等. 矫正型大动脉转位形态三尖瓣置换术及中远期结果. 中国胸心血管外科临床杂志, 2009, 16(5): 333-335.Luo ZH, Hu SS, Sun HS, et al. Mid and long-term outcomes of the morphologic tricuspid valve replacement for patients with corrected transposition of the great arteries. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2009, 16(5): 333-335.
13.	Mongeon FP, Connolly HM, et al. Congenitally corrected transposition of the great arteries: Ventricular function at the time of systemic atrioventricular valve replacement predicts long-term ventricular function. J Am Coll Cardiol, 2011, 57(20): 2008-2017.
14.	Furuta A, Shinkawa T, Okugi S, et al. Tricuspid valve replacement provides better long-term survival and tricuspid valve function than repair in patients with systemic right ventricle. JTCVS Open, 2023, 15: 382-393.
15.	Baumgartner H, De Backer J, Babu-Narayan SV, et al. ESC guidelines for the management of adult congenital heart disease. Eur Heart J, 2021, 42(6): 563-645.
16.	Färber G, Tkebuchava S, Dawson RS, et al. Minimally invasive, isolated tricuspid valve redo surgery: A safety and outcome analysis. Thorac Cardiovasc Surg, 2018, 66(7): 564-571.

1. Graham TP, Bernard YD, Mellen BG, et al. Long-term outcome in congenitally corrected transposition of the great arteries: A multi-institutional study. J Am Coll Cardiol, 2000, 36(1): 255-261.
2. Vejlstrup N, Sørensen K, Mattsson E, et al. Long-term outcome of mustard/senning correction for transposition of the great arteries in Sweden and Denmark. Circulation, 2015, 132(8): 633-638.
3. Scherptong RW, Vliegen HW, Winter MM, et al. Tricuspid valve surgery in adults with a dysfunctional systemic right ventricle: Repair or replace? Circulation, 2009, 119: 1467-1472.
4. Gupta S, McEwen C, Eqbal A, et al. Minimally invasive surgery for congenital heart disease. Ann Thorac Surg, 2023, 118(4): 953-962.
5. Murtuza B, Barron DJ, Stumper O, et al. Anatomic repair for congenitally corrected transposition of the great arteries: A single-institution 19-year experience. J Thorac Cardiovasc Surg, 2011, 142(6): 1348-1357.
6. Hornung TS, Calder L. Congenitally corrected transposition of the great arteries. Heart, 2010, 96(14): 1154-1161.
7. 李琦, 邓隆, 许建屏, 等. 三尖瓣置换术治疗成人先天性矫正性大动脉转位的远期临床结果及其危险因素分析. 中国胸心血管外科临床杂志, 2019, 26(9): 5.Li Q, Deng L, Xu JP, et al. Long-term outcome and risk factor analysis of tricuspid valve replacement for adult patients with congenitally corrected transposition of great arteries. Chin J Clin Thorac Cardiovasc Surg, 2019, 26(9): 5.
8. Devaney EJ, Charpie JR, Ohye RG, et al. Combined arterial switch and Senning operation for congenitally corrected transposition of the great arteries: patient selection and intermediate results. J Thorac Cardiovasc Surg, 2003, 125: 500-507.
9. 王新桥, 黄方炯. 矫正型大动脉转位形态三尖瓣置换术一例. 心血管外科杂志(电子版), 2015, 4(4): 198-199 .Wang XQ, Huang TF. A case of tricuspid valve replacement in corrected transposition of the great arteries. Chin J Vasc Surg(Electronic Version), 2015, 4(4): 198-199.
10. Said SM, Dearani JA, Burkhart HM, et al. Management of tricuspid regurgitation in congenital heart disease: Is survival better with valve repair? J Thorac Cardiovasc Surg, 2014, 147(1): 412-417.
11. Koolbergen DR, Ahmed Y, Bouma BJ, et al. Follow-up after tricuspid valve surgery in adult patients with systemic right ventricles. Eur J Cardiothorac Surg, 2016, 50: 456-463.
12. 罗国华, 胡盛寿, 孙寒松, 等. 矫正型大动脉转位形态三尖瓣置换术及中远期结果. 中国胸心血管外科临床杂志, 2009, 16(5): 333-335.Luo ZH, Hu SS, Sun HS, et al. Mid and long-term outcomes of the morphologic tricuspid valve replacement for patients with corrected transposition of the great arteries. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2009, 16(5): 333-335.
13. Mongeon FP, Connolly HM, et al. Congenitally corrected transposition of the great arteries: Ventricular function at the time of systemic atrioventricular valve replacement predicts long-term ventricular function. J Am Coll Cardiol, 2011, 57(20): 2008-2017.
14. Furuta A, Shinkawa T, Okugi S, et al. Tricuspid valve replacement provides better long-term survival and tricuspid valve function than repair in patients with systemic right ventricle. JTCVS Open, 2023, 15: 382-393.
15. Baumgartner H, De Backer J, Babu-Narayan SV, et al. ESC guidelines for the management of adult congenital heart disease. Eur Heart J, 2021, 42(6): 563-645.
16. Färber G, Tkebuchava S, Dawson RS, et al. Minimally invasive, isolated tricuspid valve redo surgery: A safety and outcome analysis. Thorac Cardiovasc Surg, 2018, 66(7): 564-571.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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