Thorac cardiovasc Surg 1981; 29(3): 138-142
DOI: 10.1055/s-2007-1023463
© Georg Thieme Verlag Stuttgart · New York

Further Experience with the Two-stage Anatomic Correction of Simple Transposition of the Great Arteries

A. Bernhard, M. Yacoub, D. Regensburger, H. H. Sievers, R. R. Smith, E. Stephan, P. E. Lange, E. W. Keck, P. H. Heintzen
  • Departments of Cardiovascular Surgery and Pediatric Cardiology, University of Kiel, West-Germany, Department of Thoracic and Cardiovascular Surgery, Harefield Hospital, Middlesex, England, Department of Pediatric Cardiology, University of Hamburg, West-Germany
Further Information

Publication History

1981

Publication Date:
19 March 2008 (online)

Summary

Between May 1976 and January 1981 a two-stage anatomic correction was performed in 25 patients with simple transposition of the great arteries, ranging in age from 4 1/2 to 46 1/2 months (mean 14.8). A first-stage Operation, consisting of banding of the pulmonary artery to redevelop the left ventricle, including a Blalock-Taussig-anastomosis in 4 patients was performed prior to anatomic correction. Of 33 patients, who underwent first-stage correction there were 3 early deaths (9%). The interval between the first and second stages was 5 weeks to 9 months (mean 4.3 months). After the first-stage operation, the peak systolic left ventricular pressure rose from 34±11 mmHg to 80±216 mmHg with no significant change in enddiastolic pressure. After anatomic correction there were 5 early deaths (20%) of whom 4 were due to left heart failure. There was no correlation between death and the age of the patients at the time of anatomic correction. By our current criteria the ventricles were not adequately prepared for correction in these four patients. The coronary arteries, with different types of origin, could be reimplanted to the posterior vessels without kinking, tension or torsion in all cases. After correction, the ECG and vectorcardiogram rapidly changed toward normal. The arterial oxygen saturation was higher than 95% in all patients. Recatheterization performed in 11 patients, 3 weeks to 27 months after correction, showed normal left ventricular pressure at rest in all children, except in 2 recatheterized early after correction, who had moderately elevated left ventricular enddiastolic pressure. Right ventricular peak systolic pressure decreased to normal limits. The aortic and coronary anastomoses showed normal growth in cineangiography. Although the two-stage corrections of simple TGA may have its own problems, investigation suggests that results are encouraging.