Dextro-Transposition of Great Arteries (d-TGA) was repaired by Mustard's operation in 69 patients during a 10 year period (1973-1982) in our institution. Ages at the time of surgery ranged from 3 months to 18 years, with a median age of 18 months. Factors that most affected mortality and morbidity were associated cardiac defect, the year of the operation and the age of the patient. Of the 69 patients, 26 (38%) had complex d-TGA. Early post-operative mortality was 2.38% for patients with simple transposition and 22% for the complex group. All early deaths occurred in the early part of series. Ten consecutive cases with complex transpositions in the late part of the series have done well. There were 5 late deaths--4 from the early series and these had complex transposition. Postoperative non-fatal complications included arrhythmia which occurred in 6 patients (9%). The rhythm abnormality was temporary in 2 and permanent pacing was required in 2 other patients (2.9%). There were 3 cases of late caval obstruction and 4 cases of late pulmonary venous obstruction--six of these seven patients were less then 12 months of age. Postoperative renal failure occurred in patients in the early series but was not seen in the late series. Three children developed postoperative pulmonary edema due to large bronchial collateral arteries and underwent successful collateral vessel ligation subsequent to the Mustard operation. Two patients have demonstrated late tricuspid regurgitation, are presently in heart failure and may need valve replacement.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Hypoxemia and pulmonary hyperperfusion due to systemic collateral arteries after total repair of transposition of the great arteries.

Two cases of hypoxemia and pulmonary hyperperfusion due to large bronchial collateral arteries after total repair of simple transposition of the great arteries (TGA) are presented. Pulmonary hyperperfusion was not present before total repair. Hypoxemia and congestive heart failure quickly abated after surgical ligation of these enlarged bronchial collateral arteries. The patients were totally corrected quite late (at 21 and 22 months respectively) by current standards. It is suggested that: (1) large bronchial collaterals may develop in patients with simple TGA especially if total correction is delayed; (2) preoperative angiographic evaluation of patients with simple TGA who come in for total correction late, should include special aortic root injection to exclude the presence of bronchial collaterals; (3) hypoxemia and pulmonary congestion after total correction of TGA by atrial switch procedure (Mustard or Senning) may in fact be due to bronchial collaterals and not obstruction of the pulmonary veins.

Bronchial Arteries↗

PubMedDate not supplied

Bilateral semilunar valvotomies using inflow occlusion in a neonate.

The case of a neonate with critical pulmonary and aortic valve stenosis who underwent successful sequential valvotomies using one period of inflow occlusion is reported. This valvotomy technique performed in critically ill neonates, if carried out expeditiously, can result in the same degree of success as when used for single valvotomies.

Aortic Valve↗