PROGNOSIS OF TRANSPOSITION OF THE GREAT VESSELS WITH AND WITHOUT ATRIAL SEPTAL DEFECT

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Abstract
Hanlon and Blalock, correlating the age of survival with the associated anatomical defects, in subjects having complete transposition of the great vessels, found that those with an ASD had an average survival time of 23 months, while those with a VSD had one of 49 months. The combination of a VSD and an ASD gave an average age of survival of 57 months in 19 cases. On this basis Blalock and Nanlon (1950) suggested the creation of an ASD as a palliative treatment for patients with complete transposition of the great vessels. Thirty-five patients have been seen at Guy''s Hospital and Southampton Chest Hospital with complete transposition of the great vessels in whom an anatomical diagnosis had been established. They have been divided into 3 groups, according to the nature of the septal defects, and the ages of survival analysed. It appears that in patients with transposition and a VSD, the additional occurrence of an ASD reduces the life expectancy. Reviewing the cases analysed by Blalock and Hanlon shows that their conclusions rested upon the probably inappropriate inclusion of 2 cases with long survival in the group with an ASD and a VSD. The creation of an atrial septal defect, in cases of complete transposition with a ventricular septal defect, is thought to increase the work of the heart out of proportion to the benefit derived from the increase in the magnitude of the bidirectional shunt. It is suggested that the proper indication for this operation is in a patient who has transposition with a closed ventricular septum and only a small atrial septal defect or a small patent foramen ovale.