Circulation, Vol 80, 1689-1705, Copyright © 1989 by American Heart Association
RM Di Donato, G Wernovsky, EP Walsh, SD Colan, P Lang, DL Wessel, RA Jonas, JE Mayer Jr and AR Castaneda
Between January 1983 and December 1987, 62 patients underwent an arterial
switch operation for transposition of the great arteries with ventricular
septal defect or double outlet right or left ventricle. There were three
hospital deaths (4.8%), and no deaths occurred in neonates (less than 1
month of age, n = 18). There were three late deaths, one due to coronary
obstruction and two due to pulmonary vascular obstructive disease. One
child has been lost to follow-up. We have prospectively evaluated the
remaining 55 survivors by clinical evaluation, echocardiography, cardiac
catheterization, ambulatory electrocardiographic monitoring, and limited
electrophysiologic studies. The mean length of follow-up has been 27 +/- 16
months since surgery. One child has required reoperation for a residual
ventricular septal defect; no child has undergone reoperation for
supravalvar pulmonary or aortic stenosis. Aortic regurgitation was
identified in 12 children (22%), which was mild in 11 and moderate in one.
One child has asymptomatic occlusion of the left main coronary artery, one
child has a tiny right coronary artery-to-pulmonary artery fistula, and one
child has abnormal left ventricular wall motion according to follow-up
angiography. No other abnormalities of systemic (left) ventricular function
have been identified at late follow-up. In addition to the two late deaths
due to pulmonary vascular obstructive disease, three children, all of whom
were repaired at more than 6 months of age, have elevated pulmonary
vascular resistance. Notable postoperative arrhythmias include complete
heart block in four patients and nonsustained supraventricular or
ventricular tachycardia early after surgery in eight patients (all resolved
without medication at later follow-up). Only two patients have evidence of
sinus node dysfunction and have not required treatment. The low hospital
mortality and encouraging early follow-up data represent a significant
improvement over atrial level repairs, supporting the arterial switch
operation as the procedure of choice for children who have transposition of
the great arteries with ventricular septal defect or double outlet
ventricle. Because of the potential for the development of early pulmonary
vascular obstructive disease in these patients, repair is recommended
within the first 2 months of life.
ARTICLES
Results of the arterial switch operation for transposition of the great arteries with ventricular septal defect. Surgical considerations and midterm follow-up data
Department of Cardiology, Children's Hospital, Boston, MA 02115.
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