Prognosis of transposition of the great vessels with and without atrial septal defect

Mystery still unresolved: Untouched "Blue heart" presenting at 40yrs of age

The modern-day surgical techniques and strategies have changed the outlook of patients with dextro-transposition of great arteries (d-TGA). The survival of an unrepaired d-TGA into late adulthood is difficult to explain. Even when large intracardiac shunts are present, it still remains a lethal cyanotic congenital heart disease if it is not surgically corrected soon after birth. Here, we report an extremely rare case of d-TGA presenting at 40 years of age, with moderately elevated pulmonary artery pressures and relatively stable symptoms.

Natural history of transpositon of the great arteries. Anatomy and birth and death characteristics

The natural history of transposition of the great arteries between 1957 and 1964 is presented based on a total of 742 cases. The area of study was the State of California and included 290 cases from 14 selected hospital centers. It is clear that in this era of more successful surgery, no such study will ever again be possible.

Of major importance has been a compilation of a life table so that present day cardiologists and surgeons, when evaluating whether surgery should be undertaken in a particular patient, can weigh the risk of the operative procedure against the expected number of years of life remaining if surgery is not done.

For the whole group the age of death was as follows: by 1 week, 28.7%; by 1 month, 51.6%; and by 1 year, 89.3%.

The average life expectancy at birth was 0.65 years; at 1 week of age, 0.87 years; at 1 month, 1.12 years; and at 1 year, 3.92 years.

Associated lesions had a marked effect on prognosis. The life tables presented tell a more complete story, and the pertinent data are presented in detail. (See longer summary at end of paper for further information.)

The surgical relief of transposition of the great vessels in infancy

The necessity for palliative surgery in transposition of the great vessels is indicated and the basic haemodynamics of the condition are outlined. The clinical picture of infants with transposition is divided into three types, and a method of surgical treatment is suggested for the two most common types. Our technique of investigation and treatment is described and the reasons for our choice of therapy are discussed. The results of cases operated upon are presented.

Transposition of the great arteries: surgical repair of a complicated case in a 36-year-old woman

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THE ROLE OF SURGERY IN THE TREATMENT OF TRANSPOSITION OF THE GREAT VESSELS

In 28 infants and children with complete transposition of the great vessels, atrial septal defects were created utilizing an open technique with inflow caval occlusion and moderate hypothermia. Of the 12 infants for whom operation was necessary during the first two weeks of life only two survived, suggesting that this technique is not adequate for infants at this age. Only four of the 16 children operated on between the ages of two weeks and three years failed to survive. Two of these died because of pre-existing non-cardiac conditions. Seven children with associated systemic-to-pulmonary shunts survived; the open technique may be preferable in this particular group. Despite the initial improvement afforded by this procedure, three sudden late deaths occurred. For this reason, and because of the danger of early development of pulmonary vascular disease, total operative correction of the malformation should be performed early.