A new approach to total repair of transposition of the great vessels: a technique for atrial autotransplantation.

We have devised a new operative procedure called atrial autotransplantation for transposition of the great vessels and applied it in 7 cases. Results were satisfactory except for one death. The bais of this technique was the experiment, using 70 dogs, in which the relationship of separation of the atrial wall and atrial septum to the development of arrhythmia was studied. It was found that reservation of the upper one sixth of the right atrial wall and the upper one third of the left atrial wall developed almost no significant arrhythmia with slow rate. By this concept and method, the left and right atria are almost completely separated, and a complete intraventricular and intra-atrial repair is made in a satisfactory operative field. Since there is no surgical intervention in the ventricular wall, postoperative cardiac function can be satisfactorily maintained. With this procedure intr-atrial conversion was performed in four cases and intraventricular conversion in three cases-the former for type I of uncomplicated transposition and type III of combined pulmonary stenosis, with or without VSD, and the latter for type II of combined large VSD. Only one patient with intraventricular conversion died of low cardiac output syndrome, probably due to incomplete relief of combined pulmonary stenosis.