Arterial Switch for Repair of Simple and Complex Transposition of the Great Arteries: Early Experience

Abstract

From June 1984 to December 1987, 22 neonates and infants (17 males and five females) underwent an arterial switch operation. Twelve had simple transposition of the great arteries (TGA) [+ atrial septal defect (ASD) + patent ductus arteriosus (PDA)], five had TGA + ventricular septal defect (VSD), there were two patients with double-outlet right ventricle + noncommitted inlet VSD and three with the Taussig-Bing anomaly. In the simple TGA group all patients were neonates 2–16 days old (mean 7.5 days) weighing 2.4–4.4 kg (mean 3.5 kg). The complex TGA patients were older, 10–285 days (mean 96 days) and weighed more, 3.2–8.7 kg (mean 4.1 kg).

Associated cardiac anomalies were patent ductus arteriosus (PDA) (12), aortic coarctation (two), secundum ASD (four), biscuspid aortic valve (one), significant subaortic right ventricular outflow tract obstruction (two) and subpulmonary left ventricular outflow tract obstruction (two). Fifteen patients had a “normal” coronary artery pattern. Two patients had both coronary arteries originating from one sinus, there were three patients with the LAD from sinus 1 and the RCA and Cx from sinus 2, and two patients with the RCA and LAD from sinus 1 and the Cx from sinus 2. The Lecompte maneuver was performed in all patients except three with side-to-side relationship of the great arteries.

There were two (9.1%) early deaths, one related to a technical error at operation, the other to an incorrectable coronary artery pattern. One patient died late. Nineteen patients are well and in NYHA class I 1–40 months after the correction.

The initial results of the arterial switch operation for simple and complex TGA in neonates and infants are encouraging. They compare well with the results after venous inflow redirection later in infancy if the preoperative and operative risks are considered together.