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J Thorac Cardiovasc Surg 1996;111:1289-1290
© 1996 Mosby, Inc.

LETTERS TO THE EDITOR

Transposition of the great arteries

Hôpital Marie-Lannelongue
Paris, France

Reply to the Editor:

We thank Otero-Coto for his interest in our article, ¹ for his comments, and for drawing attention to his own work on hearts with {S,D,L} segmental anatomy. ^2-5 Otero-Coto's publications deal with anatomically corrected malposition {S,D,L} (ACM), double-outlet right ventricle {S,D,L} (DORV), transposition of the great arteries {S,D,L} (TGA), and double-outlet left ventricle {S,D,L} (DOLV). He hypothesizes that despite the different possible types of ventriculoarterial alignments (ACM, DORV, TGA, or DOLV), hearts with {S,D,L} segmental anatomy nonetheless constitute a syndrome or spectrum of anomalies that may have a similar morphogenesis. ^2-5

Otero-Coto chides us by saying that TGA {S,D,L} is "not so newly recognized" a complex as we said it was. His reaction in this respect is understandable, because he well remembers his own work on this subject. ^2-5

However, we think that Otero-Coto may not have fully understood what we meant. We said: "The transposition of the great arteries {S,D,L} complex is delineated for the first time from the anatomic, diagnostic, and surgical standpoints in this study of 26 cases: 16 surgical and 10 postmortem." ¹ We did not mean to suggest that TGA {S,D,L} had never been published previously. Indeed, one of us (R.VP.) reported three postmortem cases of TGA {S,D,L} in 1968 ⁶ and six additional autopsy cases in 1977. ⁷ In our 1995 paper, ¹ we did not refer to our own previous reports of TGA {S,D,L}, ^6,7 or to those of Otero-Coto ^2-5 or others, ⁸ because our paper ¹ was not intended to be a literature review.

Instead, one of the main purposes of our recent publication ¹ was to demonstrate that TGA {S,D,L} is statistically significantly different from the more common TGA {S,D,D} in at least six different respects. This study ¹ was the first time, to our knowledge, that TGA {S,D,L} was shown by statistical analysis to be a transposition complex that is significantly different from the more common form of TGA {S,D,D}.

Six anatomic features that were found to be significantly more frequent in TGA {S,D,L} than in TGA {S,D,D} were as follows: ¹ (1) ventricular septal defect, in 96% versus 15% to 31% (p < 0.01); (2) conal septal malalignment in 80%, versus 21% (p < 0.01); (3) right ventricular hypoplasia in 50%, versus 0 (p < 0.01); (4) pulmonary outflow tract stenosis in 27%, versus 10% (p < 0.01); (5) ventricular malposition such as superoinferior ventricles and crisscross atrioventricular relations in 23%, versus 0% (p < 0.01); and (6) absent left coronary ostium resulting in "single" right coronary artery in 23%, versus 5% (p < 0.02).

This is the first study, ¹ to our knowledge, in which a quantitative mathematical method has been used to delineate what the TGA {S,D,L} complex really is.

Nonetheless, our findings and conclusions (summarized above) should be regarded as approximations. Further experience will continue to clarify the various anatomic features of the TGA {S,D,L} complex. Again, we thank Otero-Coto for his commentary.

References

1. Houyel L, Van Praagh R, Lacour-Gayet F, Serraf A, Petit J, Bruniaux J, et al. Transposition of the great arteries {S,D,L}: pathologic anatomy, diagnosis, and surgical management of a newly recognized complex. J Thorac Cardiovasc Surg 1995;110:613-24.[Abstract/Free Full Text]
   
2. Otero-Coto E, Jimenez M, Cabrera A, Deverall PB, Caffarena JM. Aortic levo-positions without ventricular inversion. Eur J Cardiol 1978;8:523-41.[Medline]
   
3. Otero-Coto E. Levoposiciones aórticas sin inversion ventricular. Tesis Doctoral. University of Oviedo (Spain). Servicio de Publicaciones. Oviedo 1977:1-15.
   
4. Otero-Coto E, Castaneda AR, Caffarena JM, Deverall PB, Cabrera A, Quero M. L-Malposed great arteries with situs solitus and concordant atrioventricular connection. J Cardiovasc Surg 1982;23:277-86.[Medline]
   
5. Otero-Coto E. Distorsiones de las relaciones atrioventriculares y ventriculoarteriales. In: Sanchez PA, editor. Cardiologia pediatrica: clinica y cirugia. 1st ed. Barcelona: Salvat Editores, 1986:561-6.
   
6. Melhuish BPP, Van Praagh R. Juxtaposition of the atrial appendages, a sign of severe cyanotic congenital heart disease. Br Heart J 1968;30:269-84.[Free Full Text]
   
7. Van Praagh R, Weinberg PM, Calder AL, Buckley LFP, Van Praagh S. The transposition complexes: How many are there? In: Davila JC, editor. Second Henry Ford Hospital international symposium on cardiac surgery. New York: Appleton-Century-Crofts, 1977:207-13.
   
8. Lincoln C, Hasse J, Anderson RH, Shinebourne E. Surgical correction in complete levotransposition of the great arteries with an unusual subaortic ventricular septal defect. Am J Cardiol 1976;38:344-51.[Medline]
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Francois Lacour-Gayet Alain Serraf Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Houyel, L. Articles by Planché,, C. Search for Related Content PubMed Articles by Houyel, L. Articles by Planché,, C.