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[Anatomic correction of transposition of the great vessels with interventricular communication. A series of 24
Insights
Surgical correction for transposition of the great arteries with ventricular septal defect offers promising results. This arterial switch operation, with or without pulmonary artery banding, can lead to asymptomatic survivors without long-term treatment needs.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Surgical Outcomes
Background:
- Transposition of the great arteries (TGA) with ventricular septal defect (VSD) is a complex congenital heart defect.
- Pulmonary artery banding (PAB) is often used as a preparatory procedure in infants with TGA and VSD.
- Surgical correction aims to restore normal arterial anatomy and improve patient survival.
Observation:
- This study reports on 24 cases of surgical correction for TGA with VSD.
- The majority of patients (19/24) underwent prior PAB in early infancy.
- Surgical correction involved VSD repair, arterial switch, and coronary reimplantation, with no prosthetic material in the outflow tract for the last 9 cases.
Findings:
- Operative mortality was 9/24, with deaths primarily linked to associated congenital or iatrogenic lesions.
- Left ventricular failure was a common postoperative complication, managed with vasodilator therapy and ventilatory support.
- Surviving children were asymptomatic post-recovery, with normal catheterization findings except for one case of pulmonary hypertension.
Implications:
- The study highlights the potential for excellent long-term outcomes following surgical correction of TGA with VSD.
- The absence of prosthetic material in the right outflow tract is a significant advantage.
- Further discussion is warranted regarding the role of PAB and the applicability of this surgical approach to simpler forms of TGA.
Abstract:
The results of surgical correction at arterial level in 24 cases of transposition of the great arteries with ventricular septal defect are reported. The majority of children (19/24) had undergone previous pulmonary artery bonding between the ages of fifteen days and 3 months (average 1,5 months). Surgical correction was performed on average 14 months later. This consisted of repair of the ventricular septal defect and arterial shift to reestablish ventriculoarterial concordance with reimplantation of the coronary arteries. In the last 9 cases no prosthetic materials were used on the right outflow tract. The operative mortality was 9/24 (6 of the first 12, and 3 of the last 12 cases). The cause of death was due to associated lesions, congenital (coarctation of the aorta, mitral valve malformation), or iatrogenic related to previous surgery (stenosis of the right ventricular infundibulum). Left ventricular failure was common despite preparation with pulmonary artery banding and merited systematic treatment mainly with arterial vasodilator therapy and prolonged ventilatory assistance. The surviving children are asymptomatic without treatment. Control catheter studies did not show any significant abnormality except in one case of pulmonary hypertension. The exceptional quality of these results, the absence of prosthetic material and the hope of reducing avoidable mortality justify this approach to surgical cure of the malformation. Preparation by pulmonary artery banding and the use of this method in "simple" forms of transposition are questions which remain open to discussion.