Anatomic correction for transposition of the great arteries: First follow-up (38 patients)

Abstract

Between April 1983 and October 1985, 38 consecutive patients with transposition of the great arteries (TGA) underwent anatomic correction. Ages ranged from 1 day to 284 weeks (mean 26.2 weeks). Simple TGA was present in 17 patients, 17 had an associated ventricular septal defect, and the remaining four had a Taussig-Bing anomaly. Hospital mortality was 2 of 38, with 1 late death. Follow-up time varied from 6 to 35 months. Postoperative cardiac catheterization was performed in 34 of the 36 early survivors. Right ventricular outflow tract obstruction with a systolic gradient greater than 20 mmHg was found in four. A residual left-to-right shunt was found in nine; Qp/Qs exceeded 2.0 in only one. In four, the pulmonary-to-systemic resistance ratio calculated was greater than 0.3. All 35 survivors are in excellent condition. Only one patient has slight aortic insufficiency. Most pre- and postoperative electrocardiographic abnormalities disappeared in due course. Echocardiography revealed normal left ventricular dimensions and fractional shortening. The aortic root diameter showed in almost all a value above the 95th percentile of normal. Postoperatively, the aortic root has grown parallel to, but above, the 95th percentile and as yet has shown no tendency to normalization.

Outcomes after Arterial Switch Operation for Simple Transposition

“…The most commonly encountered long-term morbidity following ASO is right ventricular outflow tract obstruction (RVOTO) with a reported incidence of 7% to 40%. 19,25,27,29,46 –62 Postoperative obstruction may occur at multiple levels following anatomic correction. Usually, obstruction occurs in the pulmonary trunk.…”

Growth of pulmonary artery after arterial switch operation for simple transposition of the great arteries

“…Right ventricular out¯ow tract obstruction does not appear to be a major complication of the neonatal ASO for simple TGA in contrast to the situation in Taussig-Bing anomaly or two-stage repair [1,3,7,8,9,15,22,23].…”

“…The incidence of postoperative pulmonary arterial branch stenosis mentioned in the various studies diers considerably from 3% to 30% [3,4,8,9,14,15,18,19,22,23], the more so because the criteria for a signi®cant gradient are not de®ned unanimously and because different types of catheters were used. We used a Berman catheter which has side holes, possibly overestimating gradients.…”

Switch back: Using the pulmonary autograft to replace the aortic valve after arterial switch operation

“…The current repair procedures of diaphragmatic defects in the adult, although uncommon, involve the routine use of prosthetic materials, 1 whereas the use of autologous tissues and muscular flaps is preferred in pediatric subjects. 2 The recent clarification that the paraspinous dorsal perforating branches of the lower intercostal arteries and the lumbar vessels are reliable pedicles for the use of the whole latissimus dorsi (LD) muscle as a reverse flap s prompted the use of this muscle in two experiences totaling eight children. Danbury, Conn.).…”