Impeded coronary flow in anatomic correction of transposition of the great arteries: prevention, detection, and management.

摘要: Six infants and a 3-year-old boy underwent primary anatomic repair (arterial switch) of their dextro-transposition the great arteries (d-TGA). Three died: one on operating table because an irreducible kink in left main coronary artery, postoperative bleeding tamponade, management error. In four survivors preoperative ventricular-to-right ventricular systolic pressure interrelationships were 35 to 115, 54 73, 30 80, 70 90 mm Hg. While inability take over systemic did not appear be problem any our cases, reduced perfusion seemed rule rather than exception this operation. One approach obstructed flow is first construct continuity “new” aorta, unclamp it, mark appropriate places for anastomoses fully distended aorta. It conviction that further improvement operative technique better understanding risk factors will eventually make d-TGA operation choice most dextro-transpositions.