TAUSSIG-BING ANOMALY - ARTERIAL SWITCH VERSUS KAWASHIMA INTRAVENTRICULAR REPAIR

Background Current corrective surgical approaches for the Taussig-Bing heart include arterial switch with ventricular septal defect (VSD) cl osure and intraventricular repair as described by Kawashima. Methods. Between 1983 and 1994, 20 children underwent intracardiac repair of Ta ussig-Bing anomaly. Mean age at operation was 17 months (range, 1 week to 9 years). Prior palliation included pulmonary artery band (15) wit h coarctation repair (8) and atrial septectomy (1). Arterial switch wi th VSD closure was performed in 16 patients, 10 with anteroposterior g reat arteries. Kawashima repair was performed in 4 patients, all with side-by-side great arteries. Results. After arterial switch, there was one operative death (6.2%) due to myocardial ischemia and three late deaths (18.7%) due to pulmonary hypertension, gastrointestinal bleedin g, and acute lymphocytic leukemia. In the Kawashima repair group there have been no deaths. After arterial switch, 9 patients underwent 11 r eoperations for residual coarctation (3), residual pulmonary artery st enosis (2), aortic valve replacement, aortic valvuloplasty, unrecogniz ed VSD, mitral valvuloplasty, mediastinitis, and pacemaker insertion. After Kawashima repair, 1 patient underwent reoperation for baffle ste nosis and 1 for an unrecognized VSD. Conclusions. For children with Ta ussig-Bing anomaly, the Kawashima intraventricular repair (for side-by -side great arteries) preserves the native aortic valve and avoids cor onary dissection. The arterial switch operation with VSD closure can b e applied without ventriculotomy to all great artery relationships and allows neonatal repair with or without concomitant coarctation repair . Both techniques yield excellent early and intermediate-term results despite the high rates of prerepair palliation and postrepair reoperat ion for both groups.