[Ventriculo-arterial malpositions with ventricular septal defect. Surgical indications]

Cardiac anomalies with ventriculo-arterial malposition are defined as malformations in which the aortic and/or pulmonary rings are in abnormal relation with the atrioventricular rings. When a high ventricular septal defect is also present, resection of the conal septum enables the reconstitution of normal or close to normal anatomy, without tubal interposition. Experience based upon 188 operations leads us to suggest surgical indications based upon the positions of the aortic and pulmonary rings in relation to the atrioventricular valves. Creation of the left ventricle-aorta channel may require widening of a tight ventricular septal defect, or result in resection or tilting of the conal septum onto which the tricuspid is inserted. Otherwise, left ventricle-aorta passage will be made impossible by the interposition of a straddling mitral or of tricuspid insertions which come to be inserted around the aortic ring. If the pulmonary ring is in a high, normal, position, it will not interfere with fashioning of the left channel. If situated too low, it must be shifted and reimplanted on the right ventricle. Creation of the right ventricle-pulmonary artery channel depends upon the presence or absence of concomitant pulmonary artery hypertension. In the presence of pulmonary artery hypertension, devalvulation and hence pulmonary reimplantation is poorly tolerated and is therefore contraindicated. If the pulmonary ring is in a high position (tricuspid-pulmonary distance of one normal aortic diameter for the child or more), partitioning without pulmonary displacement is the best solution.(ABSTRACT TRUNCATED AT 250 WORDS)