Palliative treatment of complete transposition of the great vessels: First clinical results of closed atrial septectomy with new septectome.

Our initial method of closed atrial septectomy, used in the palliative therapy of transposition of the great arteries (TGA), failed to produce a technical success in 1 of 5 patients. Subsequently, we modified the technique by securing the septum on traction sutures and simplifying the introduction of the septectome. With the new method, we achieved technical success in all 13 patients so treated. In our total of 18 patients treated by closed atrial septectomy, 7 had TGA with no other cardiac anomaly, and none of the 7 died. Of the remaining 11 patients who had TGA and other cardiac anomalies and required procedures such as ductus ligation, pulmonary artery banding, and aorta-right pulmonary artery shunt in addition to septectomy, 5 died. In only 1 of them, death was caused by technical complications with our initial method. Of the remaining four deaths, two were due to pre-existing cerebral damage and two to complications of palliative procedures done in conjunction with atrial septectomy. Side-to-side anastomosis between the superior vena cava and right pulmonary artery, carried out successfully in 1 case, is suggested as an additional palliative measure to supplement atrial septectomy in TGA.