Physiologic Correction of Transposition of the Great Arteries

Abstract

The total management of a group of 32 patients with transposition of the great arteries (TGA) is reported. All but one had required creation of an atrial septal defect in infancy. Eighteen patients had no associated cardiac defects, and physiologic correction was performed between 8 months and 9½ years of age. The only death in this group occurred 9 months after operation. Eight of nine patients with TGA and an associated ventricular septal defect (VSD) had required pulmonary artery banding in infancy. Physiologic correction was performed between 2¼ and 6 years of age. Three of these patients died during the postoperative period, and one died 9 months after operation. Two patients had TGA and pulmonary stenosis (PS). Physiologic correction was performed at 2 1/3 and 3¾ years of age. Both patients have done well. Three patients had TGA, VSD, and PS. Total correction was performed between 2 1/3 and 3½ years of age. All three patients died in the postoperative period. The over-all operative mortality was 19%. Our present plan of management has evolved from the experience reported above. All infants with TGA have balloon atrioseptostomy. If no VSD is present, physiologic correction is performed between 1 and 2 years of age. Patients with TGA and a VSD are catheterized at 8 months of age, and pulmonary banding is performed if pulmonary artery hypertension is present. Physiologic correction is performed at about 4 years of age. Patients with TGA, VSD, and PS may require systemicpulmonary artery anastomosis. Correction at 5 years of age with the use of a homograft from the right ventricle to the pulmonary artery, as described by Rastelli and his associates, is recommended because of the poor results obtained with an intra-atrial baffle in this group.