Improved neurological outcome following early anatomical correction of transposition of the great arteries

Abstract

The incidence of neurological residuals following anatomical correction of transposition of the great arteries (d‐TGA) has not been described so far. Clinical examination, EEG recordings, and computed tomography (CT) scans were carried out in a consecutive series of 38 children with d‐TGA surviving anatomic corrective surgery. The patients were classified into one of three groups according to the type of operation: 15 patients after two‐stage approach (TSA) (Stage 1: pulmonary artery banding + aortopulmonary shunt; Stage 2: anatomic correction); 12 patients with primary anatomic correction within the first 2 weeks of life (early switch, ES); 11 patients with primary anatomic correction later in infancy (later switch, LS). In 26 patients (68%) we found no abnormalities on neurologic examination, CT scan, or EEG. Four patients suffered from spastic hemiplegia, 3 of these had cortical brain damage visible on CT scan, and 3 had focal epilepsy as well. In 2 otherwise clinical normal patients cortical infarction could be seen on a CT scan. Thus, in 5 cases (13% of 38 patients) cerebral infarcts were diagnosed by CT scan. The cortical vascular infarction was seen in 4 patients after TSA and in 1 after LS. In 6 patients we found other neurological abnormalities. Early anatomic correction in patients with d‐TGA reduces the risk of cortical vascular infarction.