Transposition of the Great Arteries, Ventricular Septal Defect, and Left Ventricular Outflow Obstruction: Results of Conservative Correction

Summary

Sixteen children with transposition of the great arteries (TGA), ventricular septal defect (VSD), and left ventricular outflow obstruction (LVOO) underwent intracardiac correction. The atrio-ventricular relationship was concordant in all instances. The VSD was single in 13 and multiple in 2 patients. In one child a common ventricle was found. LVOO presented as valvular stenosis in 2 cases, subvalvular stenosis in 9 cases, and combined valvular and subvalvular stenosis in one case. Three patients had previously undergone banding of the pulmonary artery.

Intracardiac correction consisted in atrial inversion according to the Mustard technique. In 11 cases complete closure of the VSD was achieved. Because of incomplete subpulmonary resection, in 4 instances the VSD remained only partially closed. In the child with a common ventricle, atrial inversion without closure of the ventricular communication was performed. LVOO was treated by valvulotomy, resection of subpulmonary stenosis, or debanding of the pulmonary artery.

There were two early deaths and one late death. Because of a recurrent VSD and severe tricuspid incompetence, reintervention with VSD closure and tricuspid valve replacement was necessary in one case. All surviving patients (81%) are in good clinical condition, although only in 7 of them had the VSD initially been totally closed.

The presented results of conservative correction are comparable to those after the Rastelli operation for TGA, VSD, and LVOO. It may be advantageous, particularly in the younger children, that with this hemodynamic repair no extracardiac conduit is required.

Key-Words:

Transposition of the great arteries - VSD - LVOO - Mustard operation - Rastelli operation - Primary correction