Clinical and hemodynamic results of the two-stage anatomic correction of simple transposition of the great arteries.

Between 1976-1979, 14 patients with simple transposition of the great arteries (TGA), ranging in age from 1 month to 2 1/2 years, underwent two-stage anatomic correction. Twenty patients underwent a first-stage operation, with three early deaths (15%). After the first-stage operation the peak systolic left ventricular pressure rose from 38 +/- 6 mm Hg to 79.6 +/- 11 mm Hg, with no significant change in end-diastolic pressure or ejection fraction. This was associated with a decrease in the actual pulmonary flow but no change in effective pulmonary flow. Between the first and second stages we allowed a 5-week to 9-month interval. There were four early (29%) and no late deaths. Follow-up was 5-37 months. After an initial period of cardiac failure, all patients became asymptomatic and developed normally. Rapid changes in ECG, vectocardiogram and echocardiogram toward normal were observed. Repeat cardiac catheterization was performed in nine patients, 3 weeks to 2 1/2 years after operation. Left ventricular ejection fraction was normal in all. Two who were investigated early had mild mitral regurgitation, five had minimal aortic regurgitation and one had moderate supravalvar pulmonary stenosis. The aortic and coronary anastomoses appeared to grow normally.