Surgical Repair of Corrected Transposition of the Great Arteries with Cardiac Anomalies: A Report of Fifty-Three Cases

1996 ◽  
Vol 4 (1) ◽  
pp. 18-22
Author(s):  
Zhu Xiao Dong ◽  
Sun Han Song ◽  
Wu Qing Yu ◽  
Xiao Ming Di ◽  
Liu Ying Long
Keyword(s):  
Ventricular Septal Defect ◽  
Tricuspid Valve ◽  
Septal Defect ◽  
Perioperative Complications ◽  
Ductus Arteriosus ◽  
Pulmonary Stenosis ◽  
Fontan Operation ◽  
Tricuspid Valve Repair ◽  
Cardiac Anomalies ◽  
Corrected Transposition

Between February 1964 and June 1994, we operated on 53 patients with corrected transposition of the great arteries associated with cardiac anomalies. Their ages ranged from 2.5 to 37 years (mean 15.9 years). There were 36 patients with type SLL and 17 with type IDD. Forty-three patients had ventricular septal defect with pulmonary stenosis, 7 had VSD with pulmonary hypertension and only 3 patients had atrioventricular valve incompetence without ventricular septal defect. Atrial septal defects were found in 13 cases and patent ductus arteriosus in 2. The main operative procedures were closure of ventricular septal defect (49), closure of atrial septal defect (13), resection of pulmonary stenosis (43) and pulmonary annulus enlargement (3). Additional procedures were bypass between the morphological left ventricle and the pulmonary artery using valved external conduit (4), tricuspid valve repair (4), tricuspid valve replacement (4) and one Fontan operation. Nine patients died (17%) within 30 days of operation. The mortality rate decreased from 29.2% to 6.9% after 1988. The main cause of early death was low cardiac output syndrome. The most common perioperative complications were complete heart block (5) and residual tricuspid valve incompetence (4). Forty of the 44 survivors were followed up from 2 months to 5 years. There were 2 late deaths due to tricuspid incompetence. Our surgical experience in the prevention of operative complications are discussed.

CORRECTED TRANSPOSITION OF THE GREAT VESSELS OF THE HEART

PEDIATRICS ◽  
1957 ◽  
Vol 20 (4) ◽  
pp. 626-646
Author(s):  
Ray C. Anderson ◽  
C. Walton Lillehei ◽  
Richard G. Lester
Keyword(s):  
Ventricular Septal Defect ◽  
Pulmonary Artery ◽  
Septal Defect ◽  
Ductus Arteriosus ◽  
Pulmonary Stenosis ◽  
Main Pulmonary Artery ◽  
Laboratory Findings ◽  
Left Border ◽  
Great Vessels ◽  
Corrected Transposition

Corrected transposition of the great vessels is described, together with the probable embryologic basis for the defect. This defect has assumed great importance because of the necessity of recognizing its presence before surgical exploration for correction of the frequently associated ventricular septal defects and pulmonary stenosis. The presence of corrected transposition interferes with the surgical approach because of the anomalous coronary pattern and the inverted location of the defects. The physical and laboratory findings in 17 patients are tabulated and discussed. These included six with a ventricular septal defect, three with pulmonary stenosis, one with a ventricular and an atrial septal defect, one with a ventricular septal defect and left-sided atrioventricular valve stenosis, one with a ventricular septal defect and pulmonary stenosis, two with a reversing patent ductus arteriosus, and three with a ventricular septal defect and a small leftsided ventricle. The electrocardiogram usually shows A-V block, most often first degree, or A-V dissociation, inverted QRS patterns in the precordial leads (qR in V1 and RS in V6), peaked P waves in lead 2, widened QRS complexes, and upright T waves in the precordial leads, beginning either in RV4 or V1. Roentgenograms may demonstrate an unusual appearance of the upper left border of the heart. The main pulmonary artery may deeply indent the barium-filled esophagus, and the left pulmonary artery may be noted to be medially placed. The diagnosis can be definitely established by angiocardiography in the anteriorposterior view. The main pulmonary artery lies medially, and the aorta arises from the upper left border of the heart. Also diagnostic is the anomalous and difficult course taken by the cardiac catheter in entering the medially-placed pulmonary artery. This defect should be suspected in all patients where the pulmonary artery cannot be entered at cardiac catheterization. If pulmonary stenosis is present, the second sound below the left clavicle will not be as soft as usually noted with this defect. Certain considerations deemed of value to the surgical management of the associated intracardiac defects occurring in this series of patients with corrected transposition are presented.

Contemporary management and outcomes in congenitally corrected transposition of the great arteries

Heart ◽  
2018 ◽  
Vol 104 (14) ◽  
pp. 1148-1155 ◽  
Author(s):  
Shelby Kutty ◽  
David A Danford ◽  
Gerhard-Paul Diller ◽  
Oktay Tutarel
Keyword(s):  
Ventricular Septal Defect ◽  
Right Ventricle ◽  
Tricuspid Valve ◽  
Septal Defect ◽  
Pulmonary Stenosis ◽  
Management Strategies ◽  
Cardiovascular Complications ◽  
The Right ◽  
Congenitally Corrected Transposition ◽  
Corrected Transposition

Congenitally corrected transposition of the great arteries (ccTGA) can occur in isolation, or in combination with other structural cardiac anomalies, most commonly ventricular septal defect, pulmonary stenosis and tricuspid valve disease. Clinical recognition can be challenging, so echocardiography is often the means by which definitive diagnosis is made. The tricuspid valve and right ventricle are on the systemic arterial side of the ccTGA circulation, and are therefore subject to progressive functional deterioration. The natural history of ccTGA is also greatly influenced by the nature and severity of accompanying lesions, some of which require surgical repair. Some management strategies leave the right ventricle as the systemic arterial pump, but carry the risk of worsening heart failure. More complex ‘double switch’ repairs establish the left ventricle as the systemic pump, and include an atrial baffle to redirect venous return in combination with either arterial switch or Rastelli operation (if a suitable ventricular septal defect permits). Occasionally, the anatomic peculiarities of ccTGA do not allow straightforward biventricular repair, and Fontan palliation is a reasonable option. Regardless of the approach selected, late cardiovascular complications are relatively common, so ongoing outpatient surveillance should be established in an age-appropriate facility with expertise in congenital heart disease care.

Coarctation of the Left pulmonary artery associated with congenitally corrected transposition

1999 ◽  
Vol 9 (2) ◽  
pp. 207-209 ◽  
Author(s):  
Martial M. Massin ◽  
Götz von Bernuth
Keyword(s):  
Ventricular Septal Defect ◽  
Pulmonary Artery ◽  
Septal Defect ◽  
Pulmonary Stenosis ◽  
Left Pulmonary Artery ◽  
First Report ◽  
Ductal Tissue ◽  
Congenitally Corrected Transposition ◽  
Corrected Transposition

AbstractWe describe an infant with congenitally corrected transposition, ventricular septal defect and severe pulmonary stenosis. The heart occupied a midline position. Extension of ductal tissue had resulted in occlusion of the left pulmonary artery. As far as we are aware, this is the first report of an association of coarctation of the left pulmonary artery with corrected transposition.

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