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The Journal of Thoracic and Cardiovascular Surgery, Vol 90, 690-699, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
KR Kanter, RH Anderson, C Lincoln, ML Rigby and EA Shinebourne
Between February, 1981, and December, 1984, 30 patients underwent anatomic
correction of transposition of the great arteries with intact ventricular
septum (n = 8), transposition with ventricular septal defect (n = 15), and
double-outlet right ventricle with subpulmonary ventricular septal defect,
the Taussig-Bing anomaly (n = 7). At operation, ages ranged from 18 hours
to 6 years (mean 11.3 months) and weights ranged from 2.6 to 16.4 kg (mean
6.1 kg). The group with transposition and intact ventricular septum on
average was younger (mean 1.2 months) and smaller (mean 3.5 kg) than the
other two groups. Associated congenital heart defects were seen in 12
patients, including five with coarctation, three with multiple ventricular
septal defects, two with right ventricular hypoplasia, two with juxtaposed
atrial appendages, and one each with interrupted aortic arch,
Wolff-Parkinson- White syndrome, and left ventricular outflow tract
obstruction. All 10 patients who had undergone prior palliative operations
had pulmonary artery banding. In addition, four of these patients had
coarctation repairs, four had atrial septectomy, and one had
systemic/pulmonary shunting. All recognized patterns of coronary anatomy
were encountered. The aorta and pulmonary artery were side by side in 14
patients and anteroposterior in 16 patients. The Lecompte maneuver to
establish right ventricular-pulmonary arterial continuity was successfully
used in 12 of 13 patients with anteroposterior great vessels but in none of
those with side-by-side arteries. Seven patients had subvalvular right
ventricular outflow tract obstruction, recognized either at operation
(five) or postoperatively (two). This was responsible for death in three
patients. The 30 day hospital mortalities were as follows: one death
(12.5%) in the group with transposition and intact ventricular septum, six
deaths (40%) in the group with transposition plus ventricular septal
defect, and one death (14.3%) among patients with double-outlet right
ventricle and subpulmonary ventricular septal defect; the overall mortality
was eight deaths (26.7%). There have been no late deaths (mean follow-up
17.2 months). Ninety-five percent of the survivors are in New York Heart
Association Functional Class I. Postoperative catheterization in 13
patients has shown normal left ventricular function, no coronary stenosis,
and no aortic incompetence. Sixty-nine percent of these patients had
clinically unsuspected gradients across the right ventricular outflow
tract, which may be prevented by avoiding the Lecompte maneuver or the use
of conduits.
ARTICLES
Anatomic correction for complete transposition and double-outlet right ventricle
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