Intracardiac repair of dextro-transposition of the great arteries in the newborn period. Early and late results

Between November, 1978, and December, 1981, nine neonates with dextro-transposition of the great arteries (d-TGA) and intact ventricular septum underwent primary intracardiac repair (i.e., because of persistent hypoxemia following balloon atrial septostomy arterial Po2 between 17 and 27 mm Hg). Age and weight at operation ranged from 2 to 21 days (mean 6.7) and from 1,900 to 4,500 gm (mean 3,493), respectively. The Mustard procedure was used in the first three patients and the Senning technique in the last six. All operations were done with deep hypothermia and circulatory arrest lasting 43 to 88 minutes (mean 70). An associated patent ductus arteriosus was ligated in eight of the nine patients. There were no deaths. The patients have been followed up for an average of 23 months (range 1 to 36). All are asymptomatic and require no medication. In one patient, atrioventricular dissociation necessitated implantation of a pacemaker 2 weeks after operation. All others are in sinus rhythm with normal atrioventricular conduction. Hemodynamic and angiographic follow-up was obtained in seven patients 8 to 25 months postoperatively (average 14.5). Left ventricular pressure was less than 30 mm Hg and aortic oxygen saturation was greater than 90% in all patients. One of the patients who had the Mustard procedure had complete obstruction at the junction of the inferior vena cava and the lower limb of the baffle. No evidence of systemic venous obstruction was found in the patients who had the Senning procedure. Early primary intracardiac repair appears to be a satisfactory alternative in the treatment of neonates with persistent hypoxemia following balloon atrial septostomy.