Failure of the Jatene procedure in a patient with D-transposition and intact ventricular septum

Beneficial preparatory aortopulmonary shunt for anatomical repair of transposition of the great arteries with intact ventricular septum

Anatomical repair was successfully performed in an infant with transposition of the great arteries and intact ventricular septum who had previously received a Blalock-Taussig shunt. In this patient, creation of an aortopulmonary anastomosis induced a well-developed left ventricle with concomitant adequately increased pressure and mass. Beneficial aortopulmonary shunt that precedes the anatomical repair in selected patients with simple transposition is discussed.

Influence of the two-stage anatomic correction of simple transposition of the great arteries on left ventricular function

To evaluate the influence of the 2-stage anatomic correction of simple transposition of the great arteries on left ventricular (LV) function, pressure and angiocardiographic volume data were analyzed during resting conditions shortly before banding of the pulmonary trunk (n = 12) and before (n = 17) and after anatomic correction (n = 11), and compared with data from controls (n = 12). Age at banding and anatomic correction was between 1 and 44 months (mean 16 +/- 10) and between 13 and 47 months (mean 24 +/- 10), respectively. The interval between anatomic correction and the investigation ranged from 10 to 29 months (mean 20 +/- 7). After banding, LV ejection fraction decreased (p less than 0.01) and LV peak systolic pressure (p less than 0.01) as well as LV end-diastolic pressure (p less than 0.05) increased. After anatomic correction, these variables and LV end-systolic wall stress were not significantly different from control values. The LV end-systolic wall stress-ejection fraction relation in 7 of 11 patients after anatomic correction was within control range. The highest values were found in the youngest patients at banding and at anatomic correction. In contrast to measures of global myocardial function, such as LV ejection fraction and LV end-diastolic pressure data, the LV end-systolic stress-ejection fraction relation suggest that LV function may not be normal in some patients 20 months after anatomic correction. Young age at operation, however, appears to be advantageous in preserving LV function. Hemodynamic alterations after banding probably reflect LV adaptation to systemic pressures in a hypoxemic circulation.

Anatomic correction of transposition of the great arteries: pre- and postoperative cardiac catheterization, with angiocardiography in five patients

Six of eight patients survived anatomic correction of transposition of the great arteries and repair of associated cardiovascular anomalies at the Hospital for Sick Children, Toronto, Canada. Two of the six survivors also had tricuspid atresia, and continuity between the right atrium and the subaortic outlet chamber in these patients was provided by a valved external conduit, in addition to the arterial switch and coronary artery reimplantation. Five of the six patients have undergone complete postoperative clinical, hemodynamic and angiocardiographic investigation and form the basis of this communication. Our present indications for anatomic repair are discussed.

Coronary arteries in d-transposition. A necropsy study of reimplantation

The coronary arteries are a major concern in anatomical correction of d-transposition of the great arteries. The necropsy study was undertaken to assess the feasibility of direct bilateral reimplantation as described by Fatene et al. This seemed possible in only 30 per cent of 100 cases, and furthermore was related to the type of coronary artery pattern.