Anatomical Repair of Transposition of the Great Arteries with Intact Ventricular Septum in the Neonate: Guidelines to Avoid Complications

Research output: Contribution to journalArticle

Abstract

Anatomical repair of transposition of the great arteries (TGA) seems more attractive than the more conventional atrial baffle procedures because of resultant left ventricular–aortic continuity. The results of anatomical repair in 16 consecutive neonates with TGA and intact ventricular septum were reviewed; special consideration was given to technique and guidelines to avoid complications. Infants underwent repair within 6 days of life (average weight, 3.3 kg). Survival was 88% (14 of 16 patients). One death occurred from pulmonary hypertension and atrial shunt reversal causing cyanosis after an uncomplicated procedure; the other was due to myocardial ischemia caused by kinking of an anomalous coronary artery after attempted repair. Complications of ventricular swelling and coronary tension or kinking were successfully treated by Silastic skin patches in 2 patients and pericardial aortic patches in 2, respectively. One patient had successful repair of supravalvular pulmonary stenosis. Because anatomical repair of TGA must be performed in the first week of life, special consideration must be given to meticulous anatomical dissection, careful coronary transfer, and optimal myocardial preservation. The excellent short-term results favor the continued application of anatomical repair of TGA with intact ventricular septum in infancy.

Original languageEnglish (US)
Pages (from-to)495-501
Number of pages7
JournalAnnals of Thoracic Surgery
Volume43
Issue number5
DOIs
StatePublished - Jan 1 1987
Externally publishedYes

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Ventricular Septum
Transposition of Great Vessels
Newborn Infant
Guidelines
Cyanosis
Pulmonary Valve Stenosis
Pulmonary Hypertension
Myocardial Ischemia
Dissection
Coronary Vessels
Weights and Measures
Skin
Survival

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Anatomical Repair of Transposition of the Great Arteries with Intact Ventricular Septum in the Neonate: Guidelines to Avoid Complications",
abstract = "Anatomical repair of transposition of the great arteries (TGA) seems more attractive than the more conventional atrial baffle procedures because of resultant left ventricular–aortic continuity. The results of anatomical repair in 16 consecutive neonates with TGA and intact ventricular septum were reviewed; special consideration was given to technique and guidelines to avoid complications. Infants underwent repair within 6 days of life (average weight, 3.3 kg). Survival was 88{\%} (14 of 16 patients). One death occurred from pulmonary hypertension and atrial shunt reversal causing cyanosis after an uncomplicated procedure; the other was due to myocardial ischemia caused by kinking of an anomalous coronary artery after attempted repair. Complications of ventricular swelling and coronary tension or kinking were successfully treated by Silastic skin patches in 2 patients and pericardial aortic patches in 2, respectively. One patient had successful repair of supravalvular pulmonary stenosis. Because anatomical repair of TGA must be performed in the first week of life, special consideration must be given to meticulous anatomical dissection, careful coronary transfer, and optimal myocardial preservation. The excellent short-term results favor the continued application of anatomical repair of TGA with intact ventricular septum in infancy.",
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