Total correction of transposition of the great arteries. Conduction disturbances in infants younger than three months of age

Abstract

Although total physiological correction of d-transposition of the great arteries (d-TGA) is technically feasible in infants, the optimal age for correction has remained controversial because of concern regarding major life-threatening arrhythmias and the long-term results of the intra-atrial baffle procedure. During a 3 year period, 54 children aged 4 days to 5 years, including 24 infants aged 3 months or younger, underwent the baffle procedure. Thirty-two children had simple transposition and underwent only placement of a pericardial baffle; no deaths occurred in this group. Twenty-two had complex transposition requiring in addition closure of a ventricular septal defect (VSD) and/or resection of outflow tract obstruction; there were four hospital and two late deaths in this group. A single operative approach was used in all patients. Sinus rhythm was present at discharge in 85 percent of the infants and 76 percent of the older children. Three factors--age, mode of cardiopulmonary support, and complexity of the lesion--influenced these results.