Surgical Considerations of Ventricular Septal Defect Associated with Complete Transposition of the Great Arteries and Pulmonary Stenosis

Abstract

Ventricular septal defect (VSD) associated with complete transposition of the great arteries was studied, and each of the typical anatomic varieties was depicted to emphasize the characteristic features of the VSD. Among the 32 specimens, 13 cases were found to have a VSD lying anterosuperior to the origin of the papillary muscle of the conus, indicating that repair of the VSD could be performed without difficulty. Such a defect situated above the crista supraventricularis has proved to be technically most preferable, as shown in the case report. In contrast, the remaining 19 cases appeared to be inappropriate for the technique, as the VSD was overhung by a part of the tricuspid valve. Additional analysis was made of the angiocardiographic appearances of the VSD, demonstrating some characteristic patterns.

Comparison of types of pulmonary stenosis with the state of the ventricular septum in complete transposition of the great arteries

“…We noted an association of the infracristal type VSD and pulmonary outflow obstruction caused by anomalies of the AV valves or their attachments . The surgical approach to patients with d-TGA and VSD depends largely on the size and location of the defect [8] . Our data would suggest that knowledge of the location of the VSD may have some predictive value in determining the suitability of various surgical approaches .…”

Transposition of the great arteries with ventricular septal defect and pulmonary stenosis.

“…In transposition of the great arteries with ventricular septal defect many different types of pulmonary stenosis can be expected, valvular as well as sub- (Elliott et al, 1963;Shaher et al, 1967aShaher et al, , 1967bDaicoff et al, 1969;Rastelli et al, 1969;Fisher et al, 1970;Imamura et al, 1971;Quero-Jime'nez et al, 1973;Shaher, 1973;Quero-Jim6nez and Perez Martfnez, 1974;Lancelin et al, 1975;Quero-Jimenez et al, 1975;Shrivastava et al, 1976;Biihlmeyer et al, 1977;Quero-Jimenez et al, 1977;Van Praagh, 1977 (Lev et aL., 1961;Elliott et al., 1963;Shaher et al,, 1967b;Paul et al, 1968;Imamura et al, 1971;Shaher, 1973;Quero-jim6nez et al, 1977;Van Praagh, 1977). In this paper malalignment ventricular septal defect is described in 11 out of 19 specimens Moulaert, A. Oppenheimer-Dekker, and A. C. G. Wenink (1973,1975) and Quero-Jimenez and P6rezMartinez (1974).…”

“…The obstruction may vary from a single one to a combination of several complex abnormal structures and orientations (Elliott et al, 1963;Shaher et al, 1967aShaher et al, , 1967bDaicoffet al, 1969;Rastelli et al, 1969;Fisher et al, 1970;Imamura et al, 1971;Quero-Jimenez et al, 1973;Shaher, 1973;Quero-Jimenez and Perez Martinez, 1974;Lancelin et al, 1975;Quero-Jimenez et al, 1975;Shrivastava et al, 1976;Buihlmeyer et al, 1977;Quero-Jimenez etcal., 1977;Van Praagh, 1977).…”

“…If we exclude cases with other malformations, nonvalvular pulmonary stenosis in transposition of the great arteries with ventricular septal defect in the published reports is described in about 7 to 25 per cent of cases of transposition coming to necropsy (Lev et al, 1961;Elliott et al, 1963;Shaher et al, 1967b;Paul et al, 1968;Imamura et a!., 1971;Quero-Jimenez et al, 1973;Shaher, 1973;Van Praagh, 1977).…”