Kawashima Operation

In the presence of d-transposition of the great arteries, VSD, and side-by-side relationship of the great vessels, when arterial switch procedure is not chosen, the Kawashima operation may be used to achieve the correction. This places the left ventricle in the systemic circulation by the placement of a large comma-shaped patch in the right ventricle.

Figure 15-61. The great vessels are located side by side.

ascending aorta main pulmonary artery

Figure 15-61. The great vessels are located side by side.

Figure 15-62. A high right ventriculotomy is made, and conus muscle is resected to establish an unobstructed route for blood flow from the VSD to the aortic valve.

ventriculotomy con us muscle

Figure 15-62. A high right ventriculotomy is made, and conus muscle is resected to establish an unobstructed route for blood flow from the VSD to the aortic valve.

caud

Figure 15-63. The VSD is seen. Multiple interrupted felted mattress sutures are placed around its rim and then along the tract that leads to the aortic valve.

caud position of aortic valve ventricular septal defect

Figure 15-63. The VSD is seen. Multiple interrupted felted mattress sutures are placed around its rim and then along the tract that leads to the aortic valve.

posterior of pulmonary valve patch tunnel caud

Figure 15-64. A segment of an opened tubular Dacron® conduit is used for the tunnel patch. Care must be taken to avoid narrowing of the tunnel, which may cause left ventricular outlet obstruction.

posterior of pulmonary valve patch tunnel caud

Figure 15-64. A segment of an opened tubular Dacron® conduit is used for the tunnel patch. Care must be taken to avoid narrowing of the tunnel, which may cause left ventricular outlet obstruction.

ceph

main pulmonary artery outflow tract patch

Figure 15-65. The right ventricular outflow tract is enlarged with a patch to avoid right heart obstruction secondary to the large intraventricular baffle.

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