Case Report J Integr Cardiol, 2016, doi: 10.15761/JIC.1000181 Volume 2(5): 387-389 Journal of Integrative Cardiology ISSN: 2058-3702 Le-Compte Maneuver in surgical correction of absent pulmonary valve. Does it improve severe bronchial compression? Bulent Saritas* 1 , Emre Ozker 1 , Ozlem Sarisoy 2 , Murat Sahin 3 , Ismail Caymaz 4 , Burcak Gumus 4 , Canan Ayabakan 2 and Sait Aslamaci 1 1 Baskent University Istanbul Hospital, Cardiovascular Surgery, Istanbul, Turkey 2 Baskent University Istanbul Hospital, Pediatric Cardiology, Istanbul, Turkey 3 Adiyaman University, Pediatric Cardiology, Adiyaman,Turkey 4 Baskent University Istanbul Hospital, Interventional Radiology, Istanbul, Turkey Abstract Here,we present a case of absent pulmonary valve syndrome operated with Le-Compte maneuver. Although Le-Compte maneuver was performed, endobronshial stent placement was carried out in order to relieve the airway obstruction. Introduction Absent pulmonary valve syndrome (APVS) is seen in 3-6% of patients with tetralogy of Fallot [1]. It difers from the classical form with near absence of the pulmonary valve leafets and marked dilatation of the main pulmonary trunk and central right and lef pulmonary arteries. Te enlarged pulmonary arteries usually compress the tracheo-bronchial tree leading to respiratory distress. Anterior and posterior plication or excision of the dilated pulmonary arteries with or without retrosternal suspension are the methods usually used to relieve the bronchial compression 2 . Application of Le-Compte maneuver has been shown to provide substantial relief from obstructive respiratory symptoms in the follow-up of in these patients [2]. Here, a case of absent pulmonary valve syndrome with severe respiratory symptoms is presented. Te treatment options to alleviate the airway obstruction are discussed. Case report A 2,5 month-old boy diagnosed of TOF and APVS was intubated because of respiratuary failure and was referred to our clinic for treatment. Te echocardiographic evaluation revealed a large perimembraneous-outlet ventricular septal defect (VSD), the aorta overriding the septal defect, and absent pulmonary valve. Te pulmonary artery and the branches were massively dilated. Te respiratory symptoms were attributed to the airway compression as a result of dilated pulmonary arteries. Toracic computed tomography (CT) depicted lef bronchial obstruction (Figure 1). Te diameter of the lef main bronchus was 4.7mm proximal to the obstruction and it decreased to 2.1 mm at the level of external compression. Since the patient had severe respiratory symptoms with signifcant obstruction of the lef main bronchus, excision and plication of the dilated pulmonary arteries along with Le-Compte maneuver was planned to alleviate the bronchial compression. Surgery Te VSD was closed with a Dacron patch. Pulmonary artery and the aorta were transected. Dilated pulmonary artery and branches were excised and the plicated. Te maneuver of Le-Compte was then performed. A size 12 valved conduit was interposed between right ventricle and main pulmonary artery. Te aortic cross clamp and cardiopulmonary bypass times were 102 minutes and 150 minutes respectively. Correspondence to: Bulent Saritas, Baskent University Istanbul Hospital, Cardiovascular Surgery, Istanbul, Turkey, E-mail: HYPERLINK “mailto:bsaritas@hotmail.com” bsaritas@hotmail.com Key words: heart failure, ACE, angiotensin II, ACE2, angiotensin (1-9), angiotensin (1-7), apelin Received: August 06, 2016; Accepted: August 23, 2016; Published: August 26, 2016 Figure 1. View of preoperative CT angiogram.