Transposition of the Great Arteries

Abstract

Experience with 74 consecutive patients with transposition of the great arteries treated by palliative methods at the Children's Hospital Medical Center in Boston from June 1950 to September 1966 forms the basis for this report. Four palliative techniques were considered in detail. The specific palliative approach suggested depended on the anatomy and physiology in the individual case. Atrial septal defect creation was used largely for patients with an intact ventricular septum to improve arterial saturation, vent the left atrium, and prevent development of pulmonary vascular obstructive changes. Pulmonary artery banding was the procedure used mainly for infants with large ventricular septal defect, adequate mixing, and pulmonary arterial hypertension. The combined operation was performed on infants with ventricular defect in whom arterial-venous mixing was less than optimal through a relatively small ventricular septal defect. Arterial shunt operations were used for cyanotic infants, not in congestive failure, with ventricular septal defect and severe pulmonic stenosis. The authors recommend palliative surgery in the neonatal period for all patients with transposition of the great arteries, except for the few with type IIA lesions who have just the optimal amount of arterial saturation and absence of congestive heart failure. At present at least an 84% survival rate can be expected from the palliative surgical procedures even in the critically ill infant in the first days of life.