Surgical strategy in transposition of the great arteries with aortic arch obstruction.
OBJECTIVE
To analyze our experience in the surgical correction of transposition of the great arteries associated with aortic arch obstruction.


METHODS
From January 1998 to December 2005 we performed 223 arterial switch operations for transposition of the great arteries; 21 (9.4%) patients had associated aortic arch obstruction. Aortic arch anatomy showed: localized aortic coarctation (n=10) and coarctation with hypoplastic aortic arch (n=6) and interrupted aortic arch (n=5). Ventricular septal defect was present in 19 (90.5%) patients. Size discrepancy between the aorta and pulmonary artery and complex coronary artery anatomy were common findings. Surgical correction was performed in either one (14) or two stages (7). Aortic arch reconstruction was achieved either by resection and extended anastomoses (13) or by relocation of the ascending aorta (8).


RESULTS
Hospital mortality was 23.8% (n=5); with only one death (11.1%) among the last nine patients. Reoperations in the immediate post-operative period included: bleeding (5), residual ventricular septal defect and unrecognized coarctation (1) or residual stenosis of the aortic arch (1). There were two late deaths caused by fungal infections and reoperation for severe aortic regurgitation. Three patients underwent procedures to relieve right ventricular outflow tract obstruction. Two patients have slight to moderate aortic regurgitation.


CONCLUSIONS
The surgical treatment of transposition of the great arteries with aortic arch obstruction is complex with high morbidity. Our present choice is one-stage treatment for all patients without using homologous or heterologous tissue for aortic arch reconstruction. We recommend resection and extended anastomoses for localized coarctation and relocation of the ascending aorta for hypoplastic or interrupted aortic arch.
Gontijo Filho
Bayard
B
Biocor Institute, MG/Brazil. bayardg@uai.com.br
Fantini
Fernando Antonio
FA
Lopes
Roberto Max
RM
Martins
Cristiane Nunes
CN
Heyden
Eliana Guimarães
EG
Vrandecic
Erika Correa
EC
Peredo
Mario Osvaldo Vrandecic
MO
D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001938:Brazil / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D012086:Reoperation; D015996:Survival Rate; D014188:Transposition of Great Vessels / Q000150:complications / Q000401:mortality / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods / Q000592:standards