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The Journal of Thoracic and Cardiovascular Surgery, Vol 96, 354-363, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
C Planche, J Bruniaux, F Lacour-Gayet, J Kachaner, JP Binet, D Sidi and E Villain
From March 1984 to January 1987, anatomic surgical correction was performed
on 110 newborn infants (2 to 23 days old, mean 7.8 +/- 3.5, standard
deviation) with simple transposition of the great arteries and 10
additional neonates (7 to 30 days old, mean 17.9 +/- 8.3, standard
deviation) with transposition and a large ventricular septal defect. All
had preoperative catheterization. Ninety-six percent of the patients
underwent balloon atrial septostomy and 90% received prostaglandin E1
infusion until the time of the operation. The anatomy of the coronary
arteries according to the Yacoub classification was as follows: type A, 82
patients; type B, 5 patients; type C, 4 patients; type D, 23 patients; and
type E, 6 patients. Continuous hypothermic bypass with no circulatory
arrest was used for all patients except two. Myocardial protection was
ensured by crystalloid cardioplegia. Coronary artery relocation was
performed according to the Yacoub technique with some modifications, and
pulmonary artery reconstruction was done according to the Lecompte maneuver
in all patients, even when the great vessels had a side-by-side
relationship. The proximal pulmonary artery was reconstructed with two
circular patches for the first 10 patients and with a single large
posterior patch for the last 110 patients. Tanned heterologous pericardium
was used for the first 25 patients and autologous native pericardium for
the last 95 patients. The perioperative mortality rates were 8.3% for the
entire series and 5.4% for the last 110 patients, with no deaths in the
group having transposition plus ventricular septal defect. Late death from
acute myocardial infarction occurred in two patients in the second month
after operation. No patient was lost to follow-up, which ranged from 2 to
46 months (mean 16 +/- 11.2, standard deviation). The follow-up included
sequential noninvasive evaluations and 32 catheterizations performed 10 to
18 months postoperatively. Two patients were reoperated on for pulmonary
stenosis caused by retraction of the two heterologous pericardial patches,
but neither died. Six others have mild to moderate pulmonary stenosis. Two
patients have trivial aortic regurgitation. None have aortic dilatation or
supravalvular aortic stenosis. The 108 survivors have no cardiovascular
symptoms. They all are in sinus rhythm, have normal left ventricular
function, have no ischemic problems, and receive no medication.
ARTICLES
Switch operation for transposition of the great arteries in neonates. A study of 120 patients
Clinique de Chirurgie Cardio-vasculaire, Hopital Marie-Lannelongue, Plessis-Robinson, France.
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