The Journal of Thoracic and Cardiovascular Surgery, Vol 69, 407-414, Copyright © 1975 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Palliative treatment of complete transposition of the great vessels: First clinical results of closed atrial septectomy with new septectome
H Rastan
Our initial method of closed atrial septectomy, used in the palliative
therapy of transposition of the great arteries (TGA), failed to produce a
technical success in 1 of 5 patients. Subsequently, we modified the
technique by securing the septum on traction sutures and simplifying the
introduction of the septectome. With the new method, we achieved technical
success in all 13 patients so treated. In our total of 18 patients treated
by closed atrial septectomy, 7 had TGA with no other cardiac anomaly, and
none of the 7 died. Of the remaining 11 patients who had TGA and other
cardiac anomalies and required procedures such as ductus ligation,
pulmonary artery banding, and aorta-right pulmonary artery shunt in
addition to septectomy, 5 died. In only 1 of them, death was caused by
technical complications with our initial method. Of the remaining four
deaths, two were due to pre-existing cerebral damage and two to
complications of palliative procedures done in conjunction with atrial
septectomy. Side-to-side anastomosis between the superior vena cava and
right pulmonary artery, carried out successfully in 1 case, is suggested as
an additional palliative measure to supplement atrial septectomy in TGA.
