Transportation of great arteries: possibilities and problems of surgical treatment

Messmer, B.J.; Arbenz, U.; Real, F.

Thoraxchirurgie Vaskulare Chirurgie 23(6): 522-532


ISSN/ISBN: 0040-6384
PMID: 56055
DOI: 10.1055/s-0028-1097023
Accession: 068518897

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The principle of atrial inversion clinically introduced by Senning in 1958 remains the method of choice for total correction of isolated transposition. Simplifactions and refinement of the original technique resulted in a lower operative mortality and in significant reduction of late complications such as life threatening arrhythmias and venous inflow stenoses especially found after the original Mustard operation. Transposition complicated by ventricular septum defect with or without pulmonic stenosis remains a surgical challenge. In these cases the anatomic and hemodynamic corection with the Rastelli procedure may be of advantage. Palliative operations have a high operative risk (17% in the present series). Today, their indication is restricted to patients who are not improved after balloon-septostomy or to patients with inadequate pulmonary flow urging for pulmonary artery banding and aorto-pulmonary shunt, respectively. In isolated transposition of the great arteries primary balloon-septostomy followed by early total correction in infancy after the age of six months seems to be the most appropriate treatment today.