IMPEDED CORONARY FLOW IN ANATOMIC CORRECTION OF TRANSPOSITION OF THE GREAT-ARTERIES - PREVENTION, DETECTION, AND MANAGEMENT

  • 1 January 1982
    • journal article
    • research article
    • Vol. 83  (5) , 747-754
Abstract
Six infants and a 3-yr-old boy underwent primary anatomic repair (arterial switch) of their dextro-transposition of the great arteries (d-TGA). Three patients died: 1 on the operating table because of an irreducible kink in the left main coronary artery, 1 because of postoperative bleeding and tamponade and 1 because of a postoperative management error. In the 4 survivors the preoperative left ventricular-to-right ventricular systolic pressure interrelationships were 35-115, 54-73, 30-80 abd 70-90 mm Hg. Whle left ventricular inability to take over the synstemic pressure did not appear to be a problem in any of the cases, reduced coronary perfusion seemed to be the rule rather than the exception in this operation. One approach to the problem of obstructed coronary flow is first to construct continuity of the new aorta, unclamp it and mark the appropriate places for coronary anastomoses on the fully distended aorta. Further improvement in the operative technique and better understanding of the risk factors will eventually make the primary anatomic repair of d-TGA the operation of choice for most dextro-transpositions.

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