Postoperative hemodynamic and electrophysiologic evaluation of the interatrial baffle procedure

Hemodynamic and electrophysiologic studies were performed in 11 children with dextrotransposition of the great arteries an average of 26 months after the interatrial baffle procedure and, in 2 patients, additional closure of a ventricular septal defect. All children are clinically well. Right to left shunts ranging from 28 to 63 percent of systemic blood flow were found at the superior vena caval-baffle junction in four children. The superior vena caval-baffle gradient averaged 7 mm Hg (range 0 to 22). Right ventricular stroke work index averaged 39 g-m/beat per m2 and right ventricular end-diastolic pressure 9 mm Hg. These values were not significantly different from the values for the systemic left ventricle in a comparable group of normal children (average left ventricular stroke work index 45 g-m/beat per m2 and average left ventricular end-diastolic pressure 8 mm Hg). Cardiac index, heart rate and arteriovenous oxygen difference were also normal. No child has complete heart block. His bundle recording demonstrated normal H-V intervals (range 27 to 40 msec); 4 of the 11 had a prolonged A-H interval. Left ventricular systolic pressure was less than 40 mm Hg in all but two children who had significant subpulmonary stenosis. Pulmonary vascular resistance averaged 1.9 units and was decreased in all children. We conclude that up to 37 months postoperatively, despite some residual abnormalities, the clinical and hemodynamic condition of these children is excellent.