The story of surgical treatment of transposition of the great arteries in childhood and results of such treatment at our department
Abstract
Aim: To demonstrate the complicated evolution of techniques of the surgical treatment of transposition of the great arteries in the world as well as in our country. The successful mastery of the total correction of transposition of the great arteries using our own results has been demonstrated.
Evolution of surgery of transposition: Palliative procedures were initiated in the world by Blalock and Hanlon atrioseptectomy in 1948. Successful correction of transposition at the atrial level was started by Senning in 1959 and Mustard in 1963.
Correction of transposition at the ventricular level was suggested by Rastelli in 1969, and with correction at the arterial level performed by Jatene in 1975. The principles of the correction of transposition in newborns were fi rst published by Castaneda in 1984.
In our country, the fi rst surgical septectomy was performed in Prague in 1967, followed by the fi rst balloon septostomy in Prague in the same year. The fi rst Mustard procedure was performed in Brno in 1974.
The Senning procedure and Jatene arterial switch in the newborn were performed in Prague in 1984 and 1988, respectively. Results: The long-term results of Mustard operation (121 patients, followed up for 12 to 19 years) and Senning operation (152 patients, followed up for 5 to 20 years), performed at the Pediatric Cardiac Center, Motol University Hospital, have been published elsewhere.
Arterial correction of transposition according to Jatene was performed at the Prague Center in 358 newborns. The mortality rate decreased below 2% and the actuarial survival rate of this procedure is 96%.
The problems of the arterial switch operation are concentrated to prevention of ostial stenoses of the reimplanted coronary arteries and the development of trivial neoaortic valve regurgitation. Conclusion: Patients after successful correction of transposition of the great arteries survive into adulthood and need continuous follow-up by adult cardiologists.