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Ann Thorac Surg 1983;36:281-288
© 1983 The Society of Thoracic Surgeons

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Articles

Transposition of the Great Arteries and Ventricular Septal Defect: Results with the Senning Operation and Closure of the Ventricular Septal Defect in Infants

From the Departments of Pediatric Cardiovascular Surgery and Pediatric Cardiology, Children's Hospital Medical Center/Harvard Medical School, Boston, MA; the Department of Cardiovascular Surgery, University of Arkansas, Little Rock, AR; and the Departments of Pediatric Cardiology, University of Oregon, Portland, OR, and Hospital for Sick Children, Toronto, Ont, Canada

^* Address reprint requests to Dr. Castaneda, Children's Hospital Medical Center, 300 Longwood Ave, Boston, MA 02115

From May, 1978, to July, 1982, 46 infants ranging in age from 12 days to 12 months and in weight from 2.1 to 8.4 kg underwent repair of dextrotransposition of the great arteries (D-TGA) and ventricular septal defect (VSD) using a Senning repair and closure of the VSD. Ventricular septal defects were classified as membranous (47.8%), maialigned (28.3%), atrioventricular (AV) canal type (13.0%), subarterial (2.2%), muscular (2.2%), and multiple (6.5%). Hospital mortality was 15.2% and late mortality, 5.1%. Postoperative complications included tricuspid regurgitation (mild in 3 and severe, requiring tricuspid valve replacement, in 3), residual VSD (pulmonary/systemic flow ratio of greater than 2:1) in 3 patients (2, AV canal type and 1, multiple VSDs), pulmonary venous obstruction in 3 patients, and permanent complete heart block in 4 patients (2, AV canal type of VSD also requiring tricuspid valve replacement). Lung biopsy studies showed reversible Heath-Edwards and morphometric changes. No patient was seen with Heath-Edwards III or greater changes. In 10 patients, right ventricular end-diastolic pressures and pulmonary artery pressures at rest were within normal limits one year after operation.

As the operative mortality of atrial inversion and arterial switch operations for _d-TGA with VSD tends to become comparable, more extensive follow-up data, including cardiac catheterization and coronary arteriography in a large number of patients, will be necessary to establish the superiority of one approach over the other.

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