MEDIUM-TERM CLINICAL-RESULTS AFTER THE SENNING PROCEDURE WITH HEMODYNAMIC AND ANGIOGRAPHIC EVALUATION OF THE VENOUS PATHWAYS

Objective-To assess the clinical condition of patients and the adequac y of their newly constructed venous pathways after the Senning operati on for simple transposition of the great arteries. Patients and design -All 34 patients who had the Senning operation between March 1983 and December 1986 were reviewed. Survivors had detailed cardiac catheteris ation studies one to two years later and clinical evaluation two to si x years after surgery. Results-There were two operative deaths (6%), o ne sudden late death (after two years), and 31 survivors (91%). No cli nical evidence of obstructed venous pathways was found and there was n o need for reoperation for any reason. The average mean (SD) pressure gradient at the junction of the superior vena cava and systemic venous atrium was 2.0 (1.7) mm Hg, although two patients had gradients of 7 mm Hg. The average gradient was 0-7 (1) mm Hg in the inferior vena cav al pathway, and 1-4 (1.1) mm Hg between the mean pulmonary arterial we dge and pulmonary venous atrial pressures. Only the two patients with gradients of 7 mm Hg at the junction of the superior vena cava and the systemic venous atrium had considerable narrowing of the pathway and retrograde flow in the azygos vein to below the diaphragm. Conclusion- A small series of patients were comprehensively studied after the Senn ing operation for simple transposition of the great arteries. Scrupulo us technique in the construction of the venous pathways has had excell ent results with no need for reoperation for obstruction in either the systemic or pulmonary pathways. Clinical observation alone may fail t o identify patients with venous pathway obstruction, therefore careful assessment is required, even in patients who are physically normal.