Current Management of Transposition of the Great Arteries: Immediate Septostomy, Occasional Prostaglandin Infusion, and Early Senning Operations

Between January, 1979, and September, 1982, 30 infants with dextro(D)-transposition of the great arteries were managed with the Senning procedure for transposition of ventricular inflow. In 11 infants under 6 months of age, there were no associated cardiac malformations and no hospital deaths. Among 17 infants operated on between the ages of 6 and 12 months, 6 had associated cardiac malformations, and there were 2 hospital deaths. Two infants in the series were over 12 months of age; 1 had an associated malformation, and there were no hospital deaths. Analysis of cardiac rhythms in the postoperative period demonstrates that the first 2 patients operated on continue to have persistent junctional escape rhythm, while the remaining 26 survivors are in sinus rhythm. Twenty-four-hour Holter monitoring performed in 24 patients showed only 9 patients to be in sinus rhythm throughout the entire recording period. Seven patients had occasional atrial and ventricular premature contractions; the remainder had episodes of sinus arrest with junctional escape rhythm. Evidence of pulmonary caval or pulmonary venous obstruction has not appeared in any patient. Recently introduced technical modifications to the Mustard procedure have improved the results of that operation in regard to rhythm disturbances and baffle obstruction to venous return. This series, therefore, does not demonstrate superiority of the Senning procedure over the Mustard procedure. However, since results comparable to those of the Mustard procedure can be obtained in very young infants using the Senning operation along with deep hypothermia and circulatory arrest, the Senning procedure is deemed preferable to the Mustard procedure for this age group because of the ease with which it can be performed and because the procedure eliminates surgical judgment, and thereby surgical error, in the location of suture lines.