Correction of the transposition of the great arteries

Abstract

Inversion of the atrial flow in transposition of the great arteries is achieved in the following way: the remaining atrial septum is detached from behind, leaving it as a flap between both AV-valves. The incision is continued into the coronary sinus and the Vena magna cordis to the base of the left atrial appendage along the mitral ring. The resulting flap from the split coronary sinus is sutured to the left atrial wall in front of the left side pulmonary veins, thus forming a septum dorsal to the caval veins, diverting the left pulmonary venous blood to the right side. The atrial septal flap is reattached in front of the caval vein orifices. In 50 cases a small Dacron patch was used to complete the midportion of the new septum. Six patients died and so far we have encountered one superior Vena cava stenosis and one pulmonary vein stenosis. In 16 patients completion of the midportion of the new atrial septum was done with a partially excised flap from the right atrial wall still attached to the Vena cava inferior. This method resulted in 3 operative deaths. In 42 of 58 survivors the ECG has been repeatedly controlled 3 months to 6 years postoperatively. Thirty-six of the 42 patients have sinus rhythm, 4 vary between nodal and sinus-rhythm and 2 have a total AV-dissociation.