CORRECTED TRANSPOSITION OF THE GREAT-ARTE RIES WITH VENTRICULAR SEPTAL-DEFECT AND PULMONARY OBSTRUCTION - A STUDY OF 72 CASES

Seventy-two patients with corrected transposition of the great arterie s with ventricular septal defect and pulmonary obstruction were studie d. Four deaths occurred in the neonatal period and two were lost to fo llow-up. The remaining 66 were divided into three groups : 1) Eight pa tients were not operated on because the lesions were well compensated; they are all alive and doing well eight years later. 2) Thirty-eight patients were treated with palliative surgery: one or more systemico-p ulmonary shunts (33 cases), total cavo-pulmonary connection (1 case) a nd partial cavopulmonary connection complementary to a shunt (4 cases) . There were 3 deaths and 17 patients were lost to follow-up. However, the 18 survivors are all well seven years later. 3) The other 20 pati ents underwent surgery for severe hypoxia, after previous shunt in 18 cases. A conventional surgical protocol was respected in 17 cases (clo sure of ventricular septal defect with pulmonary disobstruction by a d irect pulmonary plasty or by ventriculo-pulmonary conduit). There were 4 deaths, 2 tricuspid valve replacements, 3 complete atrioventricular blocks requiring permanent pacing, 3 lost to follow-up and 8 good res ults after 4 years follow-up. In the last 3 cases, ''anatomical'' corr ection was attempted by tunnelling of the left ventricle to the aorta, conduit from the right ventricule to the pulmonary artery and intra-a trial Mustard procedure: these 3 children are doing well after 1 year though one of them required permanent pacing. Therefore, there is no p lace for elective surgery in this malformation; when necessary, the be st option is to remain palliative as long as possible:when correction is required, an anatomical correction is the best procedure.