Anatomical correction of transposition of the great arteries associated with a large interventricular defect

: Between December 1975 and February 1984 five patients with Transposition of the great arteries and large ventricular septal defect underwent repair by arterial switching with reimplantation of the coronary arteries. They ranged in age from 2 to 28 months and weighted between 3.2 and 10 kg. The oldest patient had underwent banding of the pulmonary artery together with a Blalock-Hanlon septectomy at 6 months of age. Direct reconstruction of the "new" pulmonary artery was achieved in 4 patients. The first of these patients operated upon on December 1975 died of acute left ventricular ischemia due to compression of the main left coronary artery caused by the newly reconstructed pulmonary artery. This death appears to be technically avoidable by using the method recently reported by Lecompte. One patient who was in good hemodynamic status died of mediastinitis 2 months after the repair. At necropsy the repair was found intact and the woven dacron conduit used to reestablish the continuity to pulmonary artery was found grossly infected. The remaining three patients continue to be asymptomatic 48, 40 and two months respectively after repair. Our small experience supports the anatomic correction as the procedure of choice for the surgical treatment of most of the patients with Transposition of the great arteries and large ventricular septal defect.