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J Thorac Cardiovasc Surg 1994;107:351-0358
© 1994 Mosby, Inc.
Surgery for Congenital Heart Disease |
Osaka, Japan
From the Departments of Cardiovascular Surgery and Pediatric Cardiology, National Cardiovascular Center, Suita, Osaka, Japan.
Received for publication Sept. 5, 1991. Accepted for publication June 16, 1993. Address for reprints: Toshikatsu Yagihara, MD, Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1, Fujishirodai, Suita, Osaka, 565, Japan.
Abstract
Since June 1987, 10 of 19 consecutive patients with atrioventricular and ventriculoarterial discordance (average age 4 ± 2 years) had undergone a double switch operation with the morphologically left ventricle used as a systemic ventricle. There were two combinations of procedures. Atrial switch combined with arterial switch was used in two patients who had a normal pulmonary valve. Atrial switch combined with ventriculoarterial switch by Rastelli's procedure was used in eight patients with pulmonary stenosis or atresia and a large ventricular septal defect. One early death and two late deaths have occurred in a postoperative follow-up period of up to 4 years. Subsequent problems were mainly related to the results of atrial switch procedures in patients who had a small atrium because of low pulmonary flow, especially in patients with apicocaval juxtaposition. Our experience suggested that the double switch operation would open a new era of definitive surgical treatment in half of the patients with atrioventricular and ventriculoarterial discordance. (J THORAC CARDIOVASC SURG 1994;107:351-8)
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