Surgical Repair of Ventricular Septal Defect Associated with Congenitally Corrected Transposition of the Great Arteries / 日本心臓血管外科学会雑誌

ABSTRACT

Sixteen patients with congenitally corrected transposition of the great arteries (CTGA) underwent operative closure of ventricular septal defects (VSD). Ages of the patients ranged from 10 months to 25 years. Three different approaches were employed to access to the defect through right ventriculotomy 3, through left ventriculotomy 5, and de Leval's maneuver 8. Here, right or left ventricle refers to its anatomic morphology. Early postoperative death occurred in a patient who concomitantly underwent extracardiac couduit repair between left ventricle and pulmonary trunk. Late death occourred in 5 (left ventriculotomy in 1 and righ ventriculotomy in 4), among whom 2 expired suddenly of unknown cause (one in each of the right and left ventriculotomy), and 1 expired of pneumonia. Two other deaths were related to their reoperations for replacement of the incompetent left atrioventricular (AV) valve. Another patient who had been repaired by de Leval's maneuver also underwent replacement of the left AV valve and survived. Two patients who had undergone left ventriculotomy developed com-plete heart block leading to implantation of permanent pacemaker. Postoperative complete heart block was temporarily noted in a patient who had been repaired by de Leval's maneuver but returned to sinus rhythm on the 10th postoperative day. Late postoperative function of the systemic ventricle was assessed in 8 by gated radionuclide ventriculography. Calculated ejection fractions in each of the methods were the followings. Left ventriculotomy 0.38, 0.47. Right ventriculotomy 0.13. de Leval's maneuver 0.29, 0.54, 0.66, 0.47, 0.36. These results draw us to the following conclusions that either ventriculotomy holds its drawbacks, that is, left ventriculotomy is apt to develop complete heart block and right ventriculotomy can predispose incompetent left AV valve ultimately leading to the fatal congestive heart failure. de Leval's maneuver, however, is rare to be complicated by the above morbidity and is considered to be the best operative method currently available.