Abstract
At present, the most promising technique for correcting transposition of the great arteries is the arterial switch with coronary reimplantation, which is also being used to correct the Taussig-Bing double outlet right ventricle. A study was undertaken in 5 postmortem hearts from 11 patients aged from 2 to 17 months (average 10.6) who underwent surgery in Salvador, Brazil, between November 1976 and October 1980. Four of these patients died during surgery and 1 soon after. The anatomical diagnoses were transposition of the great arteries in 4 and double outlet right ventricle in 1. The anatomy of each heart was carefully studied, revealing some outstanding aspects: 1) the interatrial septum was intact in 1 case, there was a patent foramem ovale in 2, an atrial septal defect created by atrioseptostomy in 1, and a single atrium in 1; 2) the interventricular septum was intact in 2 cases, a ventricular septal defect of the membranous and muscular type was found in 1 and an atrioventricular canal type in 2; 3) a ventriculotomy (40mm) for closing a ventricular septal defect was seen in 2 cases; 4) a shortened aortic stump was found in 3 cases and in 1 of these it had been necessary to interpose a dacron conduit between this stump and the pulmonary artery segment; 5) a shortened pulmonary artery stump was seen in 3 cases; 6) the caliber of the pulmonary artery stump had been reduced by 10mm in 1 of the cases to facilitate anastomosis with the pulmonary artery stump; in 2 cases there was a retraction at the level of the anastomosis between the pulmonary artery stump and the aortic segment due to disproportionate calibers; 7) in 3 cases there was a partial occlusion of the left coronary ostium, and in still another case the right coronary ostium was also partially occluded; 8) displacement of coronary artery ostia from their original sites to new ones ranged from 5 to 13mm (average 8.5mm) for the right coronary artery and from 5 to 7mm (average 6.5mm) for the left coronary artery; 9) in 1 case the left coronary artery was completely occluded very close to its point of origin, due to torsion and folding.
