Further Experience with the Two-stage Anatomic Correction of Simple Transposition of the Great Arteries

Abstract

Between May 1976 and January 1981 a two-stage anatomic correction was performed in 25 patients with simple transposition of the great arteries, ranging in age from 41/2 to 46 1/2 months (mean 14.8). A first-stage operation, consisting of banding of the pulmonary artery to redevelop the left ventricle, including a Blalock-Taussig-anastomosis in 4 patients was performed prior to anatomic correction. Of 33 patients, who underwent first-stage correction there were 3 early deaths (9%). The interval between the first and second stages was 5 weeks to 9 months (mean 4.3 months). After the first-stage operation, the peak systolic left ventricular pressure rose from 34 +/- 11 mmHg to 80 +/- 16 mmHg with no significant change in enddiastolic pressure. After anatomic correction there were 5 early deaths (20%) of whom 4 were due to left heart failure. There was no correlation between death and the age of the patients at the time of anatomic correction. By our current criteria the ventricles were not adequately prepared for correction in these four patients. The coronary arteries, with different types of origin, could be reimplanted to the posterior vessels without kinking, tension or torsion in all cases. After correction, the ECG and vectorcardiogram rapidly changed toward normal. The arterial oxygen saturation was higher than 95% in all patients. Recatheterization performed in 11 patients, 3 weeks to 27 months after correction, showed normal left ventricular pressure at rest in all children, except in 2 recatheterized early after correction, who had moderately elevated left ventricular enddiastolic pressure. Right ventricular peak systolic pressure decreased to normal limits. The aortic and coronary anastomoses showed normal growth in cineangiography. Although the two-stage corrections of simple TGA may have its own problems, investigation suggests that results are encouraging.

Response of the right ventricle to progressive pressure loading in pigs

“…Such loading conditions appear to be superior to an abrupt increase as is utilized to redevelop the myocardium of the low pressure ventricle as preparation for anatomic correction of simple transposition of the great arteries (2,9,14,(34)(35)(36). Rapid excessive increase of pressure loading leads to degenerative alterations of the myocardium (11).…”

Two-Stage Arterial Switch Operation: Is Late Ever Too Late?

“…Clinical studies have shown poor LV performance after ASO in patients with subnormal muscle thickness despite high LV pressure. 17 Although these results show that an ASO can be performed late (> 6 months), even years after initial palliation, with an acceptable mortality and morbidity, we would like to stress that undue delay can result in extensive LV hypertrophy leading to LV dysfunction, arrhythmias, and new aortic valve regurgitation and subaortic stenosis. [18][19][20]…”

Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum

“…Postoperatively, patients are weaned from inotropes and mechanical ventilation, based upon echocardiographic documentation of sustained good left ventricular function [105, 122]. In older patients, sequential tightening over several months may be necessary [124]. In the presence of a wide ASD for intercirculatory mixing, the single best predictor of SaO 2 is the magnitude of pulmonary blood flow.…”