Total Correction of Transposition of the Great Arteries Following Balloon Atrioseptostomy

Twelve patients with isolated d-TGA have undergone total correction by an interatrial baffle technique. Ten of these patients had been palliated in infancy by the BAS technique, while two patients had atrial septectomy by the Blalock-Hanlon technique. Operation was facilitated if the patient had not had a previous thoracotomy. All patients survived operation and were discharged from the hospital considerably improved. While the mean preoperative arterial oxygen tension in room air bad been 27 mm Hg, the mean postoperative tension in room air was 49 mm Hg ( P < 0.001). The most common complications were fluid retention, treated with diuretics, and arrhythmias, which in most instances were not of clinical importance. All patients eventually had an atrial pacemaker with normal atrioventricular conduction. Six patients had life-threatening complications, which included technical complications resulting in a late death, one case of postoperative intrathoracic bleeding, six pulmonary complications, two infections, one low cardiac output syndrome, one stroke, and one bleeding ulcer. All patients except one have done well since discharge, as evidenced by weight gain and further increase in arterial oxygen tension (mean 67 mm Hg). The use of the BAS technique as the sole method of palliation for TGA, combined with several technical modifications of baffle placement, have minimized postoperative complications and provided excellent results.