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Transaortic closure of ventricular septal defect in patients with corrected transposition with pulmonary stenosis or
Insights
Transaortic closure of ventricular septal defects in patients with corrected transposition offers a preferred surgical approach. This method minimizes risks such as heart block and injury to coronary arteries, improving outcomes.
Area of Science:
- Congenital Heart Surgery
- Pediatric Cardiology
- Cardiac Anatomy
Background:
- Corrected transposition of the great arteries (TGA) presents complex surgical challenges.
- Pulmonary stenosis or atresia often accompany TGA, necessitating intervention for ventricular septal defects (VSDs).
Purpose of the Study:
- To evaluate the efficacy and safety of transaortic VSD closure in patients with corrected TGA.
- To compare outcomes with other surgical techniques, focusing on minimizing complications.
Main Methods:
- Retrospective analysis of 12 patients with corrected TGA and VSD undergoing transaortic repair.
- Assessment of pre-operative and post-operative data, including hemodynamic status and associated anomalies.
- Surgical technique focused on transaortic VSD closure, with some patients receiving extracardiac conduits.
Main Results:
- Two in-hospital deaths occurred due to low cardiac output.
- Ten survivors demonstrated no complete heart block, residual VSD, aortic incompetence, or coronary arterial injury.
- Transaortic closure facilitated secure patch placement and minimized injury to critical cardiac structures.
Conclusions:
- Transaortic VSD closure is a preferred technique in corrected TGA due to reduced risk of heart block and cardiac injury.
- The surgical approach allows for optimal patch placement on the high-pressure side of the defect.
- This method potentially improves long-term outcomes for patients with complex congenital heart disease.
Abstract:
In 12 patients having corrected transposition with pulmonary stenosis (n = 8) or atresia (n = 4), the associated ventricular septal defect was repaired transaortically. Ages ranged from 4 to 50 years (mean 14.3). The hemoglobin ranged from 13.2 to 22.4 g/dl (mean 16.6), the hematocrit ranged from 40.2% to 68.2% (mean 49.0%), and the arterial oxygen saturation ranged from 63% to 97% (mean 83.8%). Associated anomalies included atrial septal defect (n = 11), double-outlet right ventricle (n = 7), dextrocardia (n = 4), and mesocardia (n = 2). Ten patients received an extracardiac conduit. There were two in-hospital deaths from low cardiac output. None of the 10 survivors had complete heart block, residual ventricular septal defect, aortic incompetence, or coronary arterial injury. Transaortic closure of ventricular septal defect is preferred in corrected transposition because it minimizes complete heart block (the conduction system courses subendocardially in the pulmonary ventricle), allows secure placement of the patch (on the high-pressure side of the defect), and limits coronary arterial and anterior papillary muscle injury (the pulmonary ventriculotomy for conduit anastomosis may be made in an apical location).