Conal anatomy in 119 patients with d-loop transposition of the great arteries and ventricular septal defect: an echocardiographic and pathologic study

Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115.

OBJECTIVES. We sought to study the range of conal morphology in transposition of the great arteries with ventricular septal defect and their embryologic and surgical implications. BACKGROUND. Conal anatomy in transposition of the great arteries and ventricular septal defect is variable and might affect surgical repair. METHODS. Conal anatomy was explored using two-dimensional echocardiography in 119 patients with transposition of the great arteries and a large ventricular septal defect who presented between 1984 and 1991. The influence of conal anatomy on surgical technique was determined by review of the operative reports. Specimens of transposition of the great arteries with unusual conal anatomy were selected from the Cardiac Registry for comparison with the echocardiograms. RESULTS. One hundred five patients (88.2%) had subaortic conus only with no subpulmonary conus (Group 1). Subarterial conus was present bilaterally in eight patients (6.7%) (Group 2). Four patients (3.4%) had only subpulmonary conus with no (or minimal) subaortic conus (Group 3). Among these four patients, the aorta was posterior to the pulmonary artery in one patient, side by side relative to the pulmonary artery in two patients and slightly anterior in the fourth patient. Subarterial conus was absent bilaterally in two patients (1.7%) (Group 4); the aorta was slightly posterior in one and side by side with the pulmonary artery in the other. CONCLUSIONS. This variability of conal anatomy in transposition of the great arteries with ventricular septal defect implies four mechanisms by which transposition can occur. The conal anatomy appeared to affect surgical repair in Groups 1 and 2 insofar as it influenced ventricular outflow tract obstruction. In Groups 3 and 4, an arterial switch operation was performed in four of the six patients. The posterior location of the aorta obviated the need for the Lecompte maneuver in two of these four patients. In the remaining two cases in Groups 3 and 4, the condition was repaired by directing the left ventricular outflow across the ventricular septal defect to the aorta using a patch, with or without placement of a conduit from the right ventricle to the pulmonary artery.

This article has been cited by other articles:

				R. V. Praagh Normally and Abnormally Related Great Arteries: What Have We Learned? World Journal for Pediatric and Congenital Heart Surgery, October 1, 2010; 1(3): 364 - 385. [Abstract] [Full Text] [PDF]

				A.-R. Hosseinpour, T. J. Jones, D. J. Barron, W. J. Brawn, and R. H. Anderson An appreciation of the structural variability in the components of the ventricular outlets in congenitally malformed hearts Eur J Cardiothorac Surg, May 1, 2007; 31(5): 888 - 893. [Abstract] [Full Text] [PDF]

				T. Tang, I.-S. Chiu, H.-C. Chen, K.-Y. Cheng, and S.-J. Chen Comparison of pulmonary arterial flow phenomena in spiral and Lecompte models by computational fluid dynamics J. Thorac. Cardiovasc. Surg., September 1, 2001; 122(3): 529 - 534. [Abstract] [Full Text] [PDF]

				C. Kreutzer, J. De Vive, G. Oppido, J. Kreutzer, K. Gauvreau, M. Freed, J. E. Mayer Jr, R. Jonas, and P. J. del Nido Twenty-five-year experience with Rastelli repair for transposition of the great arteries J. Thorac. Cardiovasc. Surg., August 1, 2000; 120(2): 211 - 223. [Abstract] [Full Text] [PDF]

				M. D. Cheitlin, J. S. Alpert, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, T. W. Davidson, J. L. Davis, P. S. Douglas, L. D. Gillam, et al. ACC/AHA Guidelines for the Clinical Application of Echocardiography : A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography) Developed in Collaboration With the American Society of Echocardiography Circulation, March 18, 1997; 95(6): 1686 - 1744. [Full Text]

				J. L. Myers Transposition of the Great Arteries Ann. Thorac. Surg., March 1, 1997; 63(3): 895 - 898. [Full Text]