90 VIABLE ATRIAL BAFFLE FOR HEMODYNAMIC CORRECTION OF TRANSPOSITION OF THE GREAT VESSELS

Abstract

Since Mustard reported pericardial baffling for correction of transposition of the great vessels, this has became the procedure of choice. Caval and pulmonary venous obstructions, tricuspid regurgitation, encroachment of atrial chambers and sudden death have occurred following this surgical technique. The purpose of this report is to present a modified baffling procedure which uses the viable atrial wall to prevent late baffle contracture and it's dreaded obstruction. A flap of pericardium preferably pedicled is used to close and form the anterior atrial wall providing a large chamber to accomodate pulmonary venous return. The procedure was performed in 5 infants 11 to 15 months old. Except for one patient who died suddenly 16 hours post-op, 4 surviving patients had smooth post-surgical courses. One patient who had an associated VSD closed, developed complete heart block but continues to maintain a ventricular rate of 68 to 72/minute. Cardiac catheterization was performed in 3 patients 6 to 8 months after their surgery. Pulmonary capillary wedge, vena caval, atrial chambers and pulmonary venous pressures showed no obstruction. The atrial pressures tended to be slightly higher than normal. Selective right and left pulmonary arteriograms were filmed and demonstrated well the unobstructive pulmonary venous return. Atrial wall baffle has the advantage that viable tissue is used and unlikely to constrict systemic and pulmonary drainage.