5-YEAR RESULTS OF ARTERIAL DETRANSPOSITIO N OF TRANSPOSITION OF THE GREAT-ARTERIES

A prospective study was performed on in-hospital patients between June 1985 and July 1992 to assess the 5 year results of surgical detranspo sition of the great arteries. Clinical examination, electrocardiograph y, echocardiography, right and left heart catheterisation with selecti ve coronary angiography, isotopic right and left ventricular ejection fractions at rest and with infusion of dobutamine and SestaMibi myocar dial perfusion scintigraphy at rest and with dipyridamole, were perfor med during the 5th year after surgery. Twenty-six children underwent t his protocol; eight others did not come for examination because they h ad moved from the region, one of whom had suffered regressive postoper ative myocardial infarction. All patients were asymptomatic and had on ly minor electrocardiographic changes. Stenosis of the pulmonary tract was observed in 38.5 % but only one case of stenosis at the origin of the right pulmonary artery required percutaneous angioplasty, which w as successful. Pulmonary regurgitation was a common echocardiographic finding (65.4 % of cases) but rarely severe (1/26: 3.9 %). Aortic regu rgitation was also observed commonly (53.8 %), nearly always mild, gra de 1 (13/14 cases). No significant stenosis of the aortic anastomosis was observed. The right and left ventricular ejection fractions were n ormal at rest except in one case and all values improved with dobutami ne. Myocardial scintigraphy did not show any perfusion defect and ther e was no stenosis or occlusion of the coronary arteries at coronary an giography. The authors conclude that the results of arterial detranspo sition at 5 years are satisfactory in this series, with no cases of ma jor obstructive lesions, major ventriculo-arterial regurgitation, vent ricular dysfunction or coronary lesions. However, longer term trials w ith larger numbers of patients are required to determine the real inci dence of coronary lesions and the long-term outcome of the pulmonary v alve in the systemic position.