[Transposition of great arteries. Results of treatment 1967-1973]

Since Rashkind's Ballon Atrio Septostomy (BAS) was introduced to this Department in Jan. 1967 93 infants with d-TGA were investigated and treated. Of these 70 were included in the study to be presented. Because of major additional anatomic defects, such as valvular atresia, underdevelopment of a ventricle or DORV 23 were excluded. - For Hamburg and the surrounding area with a population of 3-4 million we expected 20 to 30 cases of d-TGA per annum, but only 70 were seen during the 6 1/2 years period of observation. Of these, 64 were palliated by BAS. - Of 70 patients 41 were alive at the age of 6 months, while 29 died within the first 6 month of life. At present 30 are alive, 14 after total correction (Mustard); all 30 were treated with procedures such as BAS, palliative surgery or corrective surgery. - Of 70 patients 37 had simple TGA and 33 combined TGA (VSD, PDA, PS, Coarct.). The life: death ratios of these two groups are identical. - The number of palliative procedures is by far smaller in simple TGA (3) than in combined TGA (23). - The 18 Mustard operations were performed in children between 18 months and 3 1/2 years of age. Since many patients die between the age of 6 and 18 months earlier total correction is imperative. Dysrhythmias and patch shrinkage has occurred twice in 18 Mustard operations. Four patients died within 30 hours following surgery. - Many infants (29) died of simple causes such as respiratory or gastro-intestinal infections during the first 6 months after the initial BAS. A close follow up with frequent x-ray examinations and determinations of hematocrit is recommended in order to increase the rate of survival to the age when total correction is possible.