Transposition of the great arteries: Comparison of the late clinical outcome following anatomical versus physiological correction

The aim of the present study was to compare the late results of two surgical methods used in children with the transposition of the great arteries. In 27 children (group 1) the arterial switch surgery (anatomical correction) was performed and in 17 children (group 2) the Mustard or Senning procedures (physiological correction)were applied. The mean duration of follow-up was 22 months in group 1 and 47 months in group 2. During the follow-up period, repeated clinical examination, ECG, Doppler echocardiography, 24 hour ambulatory ECG monitoring, and, when required, cardiac catheterisation, were performed. The complication rate was lower in patients from group 1 compared with patients from group 2. In group 1 a significant supravalvular stenosis of pulmonary artery occurred in two children: successful transcutaneous balloon angioplasty was performed in one, whereas the other child awaits for pulmonary artery stenting. Another child from group 1 required reoperation due to residual ASD. The systolic function and contractility of the heart was normal in all patients from group 1, and no patient from this group had significant cardiac arrhythmias or conduction disturbances recorded during ambulatory ECG monitoring. In group 2 in four patients stenosis of intraatrial venous systemic canals was present; in one of them (following Mustard procedure) with transvenous gradient of 15 mm Hg an intraatrial stent was successfully placed. In the other two children a significant tricuspid insufficiency due to ventricular dilatation was present. In 10 patients from this group rhythm and/or conduction disturbances were recorded during ambulatory ECG monitoring, and two of them required pacemaker implantation. In conclusion, our results suggest that anatomical correction of the transposition of the great arteries is superior to physiological correction. Transcutaneous balloon angioplasty or stenting may be successfully used to treat some]ale postoperative complications, independently of the type of surgical correction.

Duke Scholars

Author Larry Bruce Goldstein Neurology, Stroke and Vascular Neurology