[Anatomic correction of simple transposition of the great vessels during the neonatal period. 5 years' experience in 235 children].
From March 1984 to August 1989, anatomic surgical correction was performed on 235 newborn infants (2 to 32 days old, mean 8.5 +/- 4) with simple transposition of the great arteries. Ninety-four percent of the patients underwent balloon atrial septostomy before the operation. The anatomy of the coronary arteries according to the Yacoub classification was as follows: type A, 160 patients (68%); type B, 5 patients (2%); type C, 11 patients (5%); type D, 41 patients (17%); and type E, 18 patients (8%). Coronary artery relocation was performed according to the Yacoub technique with some modifications, and the pulmonary artery reconstruction was done using the Lecompte manouver in association with a pericardial patch. The perioperative mortality rate was 8.9 percent for the entire series, significantly higher for the type C (46%, p less than 0.01) and significantly lower for the type D (0%, p less than 0.05). Seven patients were lost of follow-up. The follow-up ranged from 1 to 63 months (mean 21 +/- 14). Four late deaths occurred: 2 from myocardial infarction, 1 from pulmonary hypertension and one from a thrombotic occlusion of the superior Vena cava. One patient had an acute posterior myocardial infarction five months after the operation and his left ventricular contractility is normal at echocardiography three years later. Supravalvular pulmonary stenosis occurred in 17 patients but only two were operated on with no death. Mild aortic regurgitation occurred in nine patients. Ninety eight percent of the survivors have a normal life, with no cardiovascular symptoms and receive no medication.
Bouchart
F
F
Centre chirurgical Marie-Lannelongue, Le Plessis-Robinson.
Gérardin
B
B
Losay
J
J
Lacour-Gayet
F
F
Bruniaux
J
J
Kachaner
J
J
Dupuis
C
C
Blaysat
G
G
Planché
C
C
D000206:Actuarial Analysis; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D016019:Survival Analysis; D014188:Transposition of Great Vessels / Q000401:mortality / Q000601:surgery*
Correction anatomique en période néonatale de la transposition simple des gros vaisseaux. Une expérience de cinq and portant sur 235 enfants.