Intermediate results of the anatomic repair for congenitally corrected transposition.
BACKGROUND
Anatomic repair of congenitally corrected transposition of the great arteries has several advantages over the traditional approach but lacks long-term evaluation.


METHODS
The data on 12 patients who had the procedure between January 1989 and June 2000 were retrospectively reviewed. Associated lesions included ventricular septal defect in 12 patients, pulmonary stenosis in 10 patients, and moderate to severe tricuspid valve regurgitation in 4 patients. Mean age at operation was 9+/-3.6 months. All patients had venous switch Mustard procedure. Tunneling of the morphologic left ventricle through the ventricular septal defect to the aorta with insertion of right ventricular to pulmonary artery conduit was performed in 10 patients, and arterial switch operation in 2. Concomitant tricuspid valvuloplasty was done in 2 patients and ventricular septal defect enlargement in 1.


RESULTS
There was one hospital death (9%) in the patient who needed ventricular septal defect enlargement. Complications included atrioventricular block requiring pacemaker insertion in 1 patient (9%) and superior vena caval obstruction in 1 patient (9%). Follow-up is available on all patients 0.5 to 10 years (mean, 7.6+/-3.1 years). All patients are asymptomatic. Exercise test results on the three oldest patients were normal. Bradytachyarrhythmias developed in 4 patients (36%). Right ventricular to pulmonary artery conduit replacement was needed in 5 patients 2.2 to 7.1 years (mean 5.2+/-3.6 years) postoperatively. Mild to moderate tricuspid valve regurgitation persisted in 2 patients. Systemic left ventricular fractional shortening was 36% to 47% (mean, 39%+/-4.6%), and ejection fraction was 49% to 70% (mean, 60.8%+/-7.9%).


CONCLUSIONS
The double switch operation can be performed safely with minimal intermediate and long-term complications.
Ilbawi
Michel N
MN
University of Illinois at Chicago, The Heart Institute for Children, Hope Children's Hospital, Oak Lawn, Illinois 60453, USA.
Ocampo
Catherine B
CB
Allen
Bradley S
BS
Barth
Mary Jane
MJ
Roberson
David A
DA
Chiemmongkoltip
Pipit
P
Arcilla
Rene A
RA
D001013:Aorta, Thoracic / Q000503:physiopathology / Q000601:surgery; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D014188:Transposition of Great Vessels / Q000503:physiopathology / Q000601:surgery*