Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1980 Jun;191(6):751–758. doi: 10.1097/00000658-198006000-00014

Corrected Transposition and Ventricular Septal Defect: Surgical Experience

Carlo Marcelletti, James D Maloney, Donald G Ritter, Gordon K Danielson, Dwight C McGoon, Robert B Wallace
PMCID: PMC1344790  PMID: 7387237

Abstract

The entire 21-year experience at our institution with intracardiac repair of corrected transposition of the great arteries (CTGA) associated with ventricular septal defect (VSD) is reviewed. There were 53 such operations. The hospital mortality rate fell from 50% before 1972 to 18% since then (p < 0.02), and was 19% when a systemic ventriculotomy was not used compared to 60% when it was used (p < 0.01). A technique is described for correction of CTGA with VSD and pulmonary outflow tract obstruction (POTO) designed to minimize risk of heart block and to increase the degree of relief of POTO: the VSD patch is placed to the right side of the conduction tissue and the pulmonary outflow tract, and POTO is bypassed with an extracardiac conduit. This technique reduced the incidence of complete heart block from 67% by direct relief of POTO to 28% (p < 0.05) and decreased the frequency of inadequate relief of POTO from 50% to 8% (p < 0.01). However, experience with these two approaches was not concurrent. Successful intraoperative mapping of the conduction bundle was associated with operatively induced heart block in 37%, whereas prior to the availability of mapping the incidence of heart block was 57% (difference not significant). Twelve patients required atrioventricular (AV) valve repair or replacement, and in them the operative mortality was 50%, compared to 20% in the remainder (p < 0.05). For the 21 patients with VSD and POTO who achieved good relief of POTO, the operative mortality was only 5%. These findings suggest that good progress has been made in the surgical repair of CTGA with VSD, though further improvement in results is required.

Full text

PDF
751

Images in this article

753Fig. 1.
on p.753
754Fig. 2.
on p.754

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ANDERSON R. C., LILLEHEI C. W., LESTER R. G. Corrected transposition of the great vessels of the heart: a review of 17 cases. Pediatrics. 1957 Oct;20(4):626–646. [PubMed] [Google Scholar]
  2. Allwork S. P., Bentall H. H., Becker A. E., Cameron H., Gerlis L. M., Wilkinson J. L., Anderson R. H. Congenitally corrected transposition of the great arteries: morphologic study of 32 cases. Am J Cardiol. 1976 Dec;38(7):910–923. doi: 10.1016/0002-9149(76)90804-3. [DOI] [PubMed] [Google Scholar]
  3. Anderson R. H., Arnold R., Wilkinson J. L. The conducting system in congenitally corrected transposition. Lancet. 1973 Jun 9;1(7815):1286–1288. doi: 10.1016/s0140-6736(73)91299-3. [DOI] [PubMed] [Google Scholar]
  4. Anderson R. H., Becker A. E., Arnold R., Wilkinson J. L. The conducting tissues in congenitally corrected transposition. Circulation. 1974 Nov;50(5):911–923. doi: 10.1161/01.cir.50.5.911. [DOI] [PubMed] [Google Scholar]
  5. Anderson R. H., Becker A. E., Gerlis L. M. The pulmonary outflow tract in classically corrected transposition. J Thorac Cardiovasc Surg. 1975 May;69(5):747–757. [PubMed] [Google Scholar]
  6. BECU L. M., SWAN H. J., DUSHANE J. W., EDWARDS J. E. Cardiac clinics. CXLIV. Ebstein malformation of the left atrioventricular valve in corrected transposition of the great vessels with ventricular septal defect. Proc Staff Meet Mayo Clin. 1955 Oct 19;30(21):483–490. [PubMed] [Google Scholar]
  7. BERRY W. B., ROBERTS W. C., MORROW A. G., BRAUNWALD E. CORRECTED TRANSPOSITION OF THE AORTA AND PULMONARY TRUNK: CLINICAL, HEMODYNAMIC AND PATHOLOGIC FINDINGS. Am J Med. 1964 Jan;36:35–53. doi: 10.1016/0002-9343(64)90146-9. [DOI] [PubMed] [Google Scholar]
  8. Bonfils-Roberts E. A., Guller B., McGoon D. C., Danielson G. K. Corrected transposition. Surgical treatment of associated anomalies. Ann Thorac Surg. 1974 Feb;17(2):200–209. doi: 10.1016/s0003-4975(10)65635-4. [DOI] [PubMed] [Google Scholar]
  9. Ciaravella J. M., Jr, McGoon D. C., Danielson G. K., Wallace R. B., Mair D. D., Ilstrup D. M. Experience with the extracardiac conduit. J Thorac Cardiovasc Surg. 1979 Dec;78(6):920–930. [PubMed] [Google Scholar]
  10. EDWARDS J. E. Differential diagnosis of mitral stenosis; a clinicopathologic review of simulating conditions. Lab Invest. 1954 Mar-Apr;3(2):89–115. [PubMed] [Google Scholar]
  11. EL SAYED H., CLELAND W. P., BENTALL H. H., MELROSE D. G., BISHOP M. B., MORGAN J., GIBBON J. H., Jr Corrected transposition of the great arterial trunks: surgical treatment of the associated defects. J Thorac Cardiovasc Surg. 1962 Oct;44:443–458. [PubMed] [Google Scholar]
  12. Fox L. S., Kirklin J. W., Pacifico A. D., Waldo A. L., Bargeron L. M., Jr Intracardiac repair of cardiac malformations with atrioventricular discordance. Circulation. 1976 Jul;54(1):123–127. doi: 10.1161/01.cir.54.1.123. [DOI] [PubMed] [Google Scholar]
  13. Friedberg D. Z., Nadas A. S. Clinical profile of patients with congenital corrected transposition of the great arteries. A study of 60 cases. N Engl J Med. 1970 May 7;282(19):1053–1059. doi: 10.1056/NEJM197005072821901. [DOI] [PubMed] [Google Scholar]
  14. Kinsley R. H., McGoon D. C., Danielson G. K. Corrected transposition of the great arteries: associated ventricular rotation. Circulation. 1974 Mar;49(3):574–578. doi: 10.1161/01.cir.49.3.574. [DOI] [PubMed] [Google Scholar]
  15. Kupersmith J., Krongrad E., Gersony W. M., Bowman F. O., Jr Electrophysiologic identification of the specialized conduction system in corrected transposition of the great arteries. Circulation. 1974 Oct;50(4):795–800. doi: 10.1161/01.cir.50.4.795. [DOI] [PubMed] [Google Scholar]
  16. LEV M., LICATA R. H., MAY R. C. THE CONDUCTION SYSTEM IN MIXED LEVOCARDIA WITH VENTRICULAR INVERSION (CORRECTED TRANSPOSITION). Circulation. 1963 Aug;28:232–237. doi: 10.1161/01.cir.28.2.232. [DOI] [PubMed] [Google Scholar]
  17. Maloney J. D., Ritter D. G., McGoon D. C., Danielson G. K. Identification of the conduction system in corrected transposition and common ventricle at operation. Mayo Clin Proc. 1975 Jul;50(7):387–394. [PubMed] [Google Scholar]
  18. Pilapil V. R., Bennett K. R., Watson D. G., Lehan P. H. Corrected transposition of the great arteries. A study of twelve cases. Am J Med. 1971 Oct;51(4):482–490. doi: 10.1016/0002-9343(71)90254-3. [DOI] [PubMed] [Google Scholar]
  19. RASTELLI G. C., ONGLEY P. A., DAVIS G. D., KIRKLIN J. W. SURGICAL REPAIR FOR PULMONARY VALVE ATRESIA WITH CORONARY-PULMONARY ARTERY FISTULA: REPORT OF CASE. Mayo Clin Proc. 1965 Jul;40:521–527. [PubMed] [Google Scholar]
  20. Santoli C., Gordini V., Filomeni D., Fancini P., Pellegrini A. Il trattamento chirurgico delle anomalie cardiache associate alla trasposizione corretta dei grossi vasi. G Ital Cardiol. 1975;5(4):489–505. [PubMed] [Google Scholar]
  21. Shem-Tov A., Deutsch V., Yahini J. H., Kraus Y., Neufeld H. N. Corrected transposition of the great arteries. A modified approach to the clinical diagnosis in 30 cases. Am J Cardiol. 1971 Jan;27(1):99–113. doi: 10.1016/0002-9149(71)90088-9. [DOI] [PubMed] [Google Scholar]
  22. Skow J. R., Mulder D. G. Atrial approach for repair of ventricular septal defect in corrected transposition. J Thorac Cardiovasc Surg. 1974 Mar;67(3):426–429. [PubMed] [Google Scholar]
  23. Van Praagh R. What is congenitally corrected transposition? N Engl J Med. 1970 May 7;282(19):1097–1098. doi: 10.1056/NEJM197005072821912. [DOI] [PubMed] [Google Scholar]
  24. Waldo A. L., Pacifico A. D., Bargeron L. M., James T. N., Kirklin J. W. Electrophysiological delineation of the specialized A-V conduction system in patients with corrected transposition of the great vessels and ventricular septal defect. Circulation. 1975 Sep;52(3):435–441. doi: 10.1161/01.cir.52.3.435. [DOI] [PubMed] [Google Scholar]
  25. de Leval M. R., Bastos P., Stark J., Taylor J. F., Macartney F. J., Anderson R. H. Surgical technique to reduce the risks of heart block following closure of ventricular septal defect in atrioventricular discordance. J Thorac Cardiovasc Surg. 1979 Oct;78(4):515–526. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES