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.
Key Words
Simple D-transposition of the great arteries - Two-stage anatomic correction - Postoperative
studies
