The anatomo-pathological findings in Jatene's procedure

At present, the most promising technique for correcting transposition of the great arteries is the arterial switch with coronary reimplantation, which is also being used to correct the Taussig-Bing double outlet right ventricle. A study was undertaken in 5 postmortem hearts from 11 patients aged from 2 to 17 months (average 10.6) who underwent surgery in Salvador, Brazil, between November 1976 and October 1980. Four of these patients died during surgery and 1 soon after. The anatomical diagnoses were transposition of the great arteries in 4 and double outlet right ventricle in 1. The anatomy of each heart was carefully studied, revealing some outstanding aspects: the interatrial septum was intact in 1 case, there was a patent foramem ovale in 2, an atrial septal defect created by atrioseptostomy in 1, and a single atrium in 1; the interventricular septum was intact in 2 cases, a ventricular septal defect of the membranous and muscular type was found in 1 and an atrioventricular canal type in 2; a ventriculotomy (40 mm) for closing a ventricular septal defect was seen in 2 cases; a shortened aortic stump was found in 3 cases and in 1 of these it had been necessary to interpose a dacron conduit between this stump and the pulmonary artery segment; a shortened pulmonary artery stump was seen in 3 cases; the caliber of the pulmonary artery stump had been reduced by 10 mm in 1 of the cases to facilitate anastomosis with the pulmonary artery stump; in 2 cases there was a retraction at the level of the anastomosis between the pulmonary artery stump and the aortic segment due to disproportionate calibers; in 3 cases there was a partial occlusion of the left coronary ostium, and in still another case the right coronary ostium was also partially occluded; displacement of coronary artery ostia from their original sites to new ones ranged from 5 to 13 mm (average 8.5 mm) for the right coronary artery and from 5 to 7 mm (average 6.5 mm) for the left coronary artery; in 1 case the left coronary artery was completely occluded very close to its point of origin, due to torsion and folding.