Anatomical repair of transposition of the great arteries with intact ventricular septum in the neonate: guidelines to avoid complications.

Anatomical repair of transposition of the great arteries (TGA) seems more attractive than the more conventional atrial baffle procedures because of resultant left ventricular-aortic continuity. The results of anatomical repair in 16 consecutive neonates with TGA and intact ventricular septum were reviewed; special consideration was given to technique and guidelines to avoid complications. Infants underwent repair within 6 days of life (average weight, 3.3 kg). Survival was 88% (14 of 16 patients). One death occurred from pulmonary hypertension and atrial shunt reversal causing cyanosis after an uncomplicated procedure; the other was due to myocardial ischemia caused by kinking of an anomalous coronary artery after attempted repair. Complications of ventricular swelling and coronary tension or kinking were successfully treated by Silastic skin patches in 2 patients and pericardial aortic patches in 2, respectively. One patient had successful repair of supravalvular pulmonary stenosis. Because anatomical repair of TGA must be performed in the first week of life, special consideration must be given to meticulous anatomical dissection, careful coronary transfer, and optimal myocardial preservation. The excellent short-term results favor the continued application of anatomical repair of TGA with intact ventricular septum in infancy.