Systemic atrioventricular valve replacement in an infant with corrected transposition of the great arteries

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

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.