Management of transposition of the great arteries: switch arterial

pp 40-45

Abstract

The transposition of the great arteries is a serious disease, with a mortality above 90 % during the first year of life unless the correct treatment is instituted. The atrial-inversion procedures, have been a useful resource in the surgeon's hand for the treatment of this pathology, for more than twenty years, with a very low mortality, but with a serious morbidity in the follow-up. Included among these, we can count a 50 % of patients suffering from sinus node disease, in follow-up up to 15 years, and a 10 % of these having a pacemaker im- planted in follow-up at 10 years. On the other hand, there is a significant number of residual anatomic defects, including tricuspid insufficiency and atriocaval stenosis, and finaDy cases of sudden death among patients with arrhythmias either symptomatic or asymptomatic. Advances in earlier diagnostic, pre and post- operative management, as well as technical improvements, have made the Jatene's operation or arterial switch a valid alternative. Between January 1983 and July 1990, at the Boston Children's Hospital 344 arterial switch were performed, with a hospital mortality of 8 %, reaching during the last two years a 2.5 %; and with a low morbidity, including a 2% of pulmonic stenosis, and a 15 % of minimal aortic regurgitation. We think that the surgeon has to offer to the patient a valid alternative treatment, with not only a low mortality, but a fear life quality as well. Furthermore we believe that in 1990 the arterial switch procedure is the treatment of choice for transposition of the great arteries, with or without ventricular septal defect.