Transposition of the great arteries with ventricular septal defect. Palliation by atrial septostomy and pulmonary artery banding.

Abstract

Infants with transposed great arteries need atrioseptostomy for adequate intracardiac mixing of the systemic and pulmonic circulations. Those with ventricular septal defect and pulmonary artery hypertension, with or without other associated lesions, usually require further surgical palliation. Postseptostomy measurements of pulmonary artery pressures at systemic levels were obtained in ten infants with transposition of the great arteries and ventricular septal defects. Three had, in addition, patent ductus arteriosus, and two of these had aortic coarctation (one preductal with hypoplasia of the aortic arch). One had transposition of the great arteries, ventricular septal defect, and tricuspid atresia. Four of the patients had surgical septectomy; the remaining seven had balloon atrioseptostomy. All had pulmonary artery banding; the three ductus arteriosus lesions were ligated; and both coarctations were repaired (one with reconstruction of the aortic arch). The only operative death was in one of the patients with transposition of the great arteries and ventricular septal defect only. When the interatrial communication is adequate in patients with transposition, ventricular septal defect, and pulmonary artery hypertension, pulmonary vascular obstructive changes may be prevented by pulmonary artery banding and surgical correction of the associated lesions.