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(Circulation. 1995;92:272-278.)
© 1995 American Heart Association, Inc.

Articles

Intermediate-Term Outcome After Intracardiac Repair of Associated Cardiac Defects in Patients With Atrioventricular and Ventriculoarterial Discordance

Presented in part at the 67th Scientific Sessions of the American Heart Association, Dallas, Tex, November 14-17, 1994, and published in abstract form (Circulation. 1994;90[suppl II]:II-97).

Tetsuya Sano, MD, PhD; Thomas Riesenfeld, BSC, MD; Tom R. Karl, MS, MD; James L. Wilkinson, MB, FRCP, FRACP

From the Department of Cardiology and Victorian Paediatric Cardiac Surgical Unit, Royal Children's Hospital, Melbourne, Australia.

Correspondence to Dr James L. Wilkinson, Department of Cardiology, Royal Children's Hospital, Melbourne, Flemington Rd, Parkville, Victoria 3052, Australia.

Background Limited information is available concerning long-term results, especially systemic right ventricular (RV) or tricuspid valvular function, after intracardiac repair of anomalies associated with discordant atrioventricular (AV) and ventriculoarterial (VA) connections ("congenitally corrected transposition of the great arteries").

Methods and Results We retrospectively reviewed the intermediate-term follow-up of 28 patients, totaling 158 patient-years (median, 60 months), after intracardiac repair involving closure of a ventricular septal defect (VSD) with or without additional surgery. Seven patients had VSD closure alone, 5 had VSD repair with pulmonary stenosis relief, and 16 had VSD closure with conduit insertion between left ventricle and main pulmonary artery. Hospital mortality was 4% (1 of 28 patients; 70% confidence limits, 0.07% to 12%) and the 1-, 5-, and 10-year actuarial survival probabilities were 89%, 83%, and 83%, respectively. Twenty-one of 24 long-term survivors were in New York Heart Association functional class I and 3 were in class II. Sixteen of 24 patients showed increasing tricuspid regurgitation (TR) of more than moderate degree, which occurred within 3 years after surgery in 7 patients. Twelve of 22 patients showed deterioration of RV pump function, mainly (9 of 12 patients) within 3 years postoperatively. The pulmonary to systemic flow ratio at the preoperative cardiac catheter study was significantly (P<.05) higher in patients who developed RV dysfunction (2.3±1.0, mean±SD) than in those with well-maintained RV function (1.4±0.6).

Conclusions Intermediate-term results of intracardiac repair for AV and VA discordance were satisfactory in terms of survival and clinical functional status; however, there is concern about systemic RV dysfunction with development of TR relatively early after the operation. Alternative surgical approaches such as anatomic correction or Fontan repair for cases unsuitable for biventricular repair may improve the long-term results, including ventricular and valvular function.

Key Words: regurgitation • prognosis • transposition of great vessels • myocardial contraction • surgery