[Neonatal anatomical repair of transposition of great vessels associated with atrial septal defect. Apropos of 42 cases].
The good results obtained by anatomic correction of simple transposition of the great arteries (TGA) in the neonatal period have incited some surgical teams to widen the indications to neonates with TGA associated with ventricular septal defect (VSD). The classical management of these patients is a two stage procedure: banding of the pulmonary artery followed by detransposition, which carries a certain risk. Between January 1985 and June 1990, 42 neonates with TGA and VSD underwent a combined procedure consisting in anatomic correction of the TGA and closure of the VSD. The average age of these patients was 16 days, and the average weight was 3.3 kg. Ten patients had coarctation and 6 underwent a complete one stage correction by an anterior approach. The surgical technique consisted in closing the VSD from the right atrium in 20 patients, from the right ventricle in 11 patients and from the pulmonary artery in 11 patients, associated with detransposition of the great arteries and coronary artery reimplantation. Three children died in the preoperative period (7.1%). In two cases, death was related to malposition of the coronary artery. The third fatality was the result of haemorrhage. There has been one late death three years after surgery. Four patients have been reoperated for stenosis of the right ventricular outflow tract (1 case), recurrence of coarctation (2 cases) and stenosis of the superior vena cava (1 case) and have survived. All patients were followed up for an average period of 26.4 +/- 19 months. They are all in the NYHA Class I without treatment. One patient has mild aortic regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)
Planché
C
C
Département de chirurgie cardiaque pédiatrique, Hôpital Marie-Lannelongue, Le Plessis-Robinson.
Serraf
A
A
Bruniaux
J
J
Lacour-Gayet
F
F
Bouchart
F
F
Losay
J
J
Touchot
A
A
D000206:Actuarial Analysis; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011651:Pulmonary Artery / Q000601:surgery; D012086:Reoperation; D016019:Survival Analysis; D014188:Transposition of Great Vessels / Q000150:complications / Q000401:mortality / Q000601:surgery*
Correction anatomique néonatale de la transposition des gros vaisseaux associée à une communication interventriculaire. A propos de 42 cas.