Summary
Sixteen children with transposition of the great arteries (TGA), ventricular septal
defect (VSD), and left ventricular outflow obstruction (LVOO) underwent intracardiac
correction. The atrio-ventricular relationship was concordant in all instances. The
VSD was single in 13 and multiple in 2 patients. In one child a common ventricle was
found. LVOO presented as valvular stenosis in 2 cases, subvalvular stenosis in 9 cases,
and combined valvular and subvalvular stenosis in one case. Three patients had previously
undergone banding of the pulmonary artery.
Intracardiac correction consisted in atrial inversion according to the Mustard technique.
In 11 cases complete closure of the VSD was achieved. Because of incomplete subpulmonary
resection, in 4 instances the VSD remained only partially closed. In the child with
a common ventricle, atrial inversion without closure of the ventricular communication
was performed. LVOO was treated by valvulotomy, resection of subpulmonary stenosis,
or debanding of the pulmonary artery.
There were two early deaths and one late death. Because of a recurrent VSD and severe
tricuspid incompetence, reintervention with VSD closure and tricuspid valve replacement
was necessary in one case. All surviving patients (81%) are in good clinical condition,
although only in 7 of them had the VSD initially been totally closed.
The presented results of conservative correction are comparable to those after the
Rastelli operation for TGA, VSD, and LVOO. It may be advantageous, particularly in
the younger children, that with this hemodynamic repair no extracardiac conduit is
required.
Key-Words:
Transposition of the great arteries - VSD - LVOO - Mustard operation - Rastelli operation
- Primary correction
