Transposition of great arteries. A study of 65 infants followed for 1 to 4 years after balloon septostomy.

Abstract

Though the outlook for children with transposition of the great arteries has been transformed by modern methods of treatment, the initial improvement after balloon septostomy may raise false hopes. A relatively longfollow-up of thefirst 65 consecutive cases treated between November 1966 and December I969 shows the serious risks to which these infants are exposed: 32 children have died, 5 during or immediately after septostomy; I8 needed further septostomies and 12 of these have died. The influence of coexistent heart lesions has been analysed and the effect on pulmonary vascular resistance assessed, demonstrating that a ventricular septal defect or a persistent ductus arteriosus does not always need surgical treatment to prevent pulmonary hypertension. Intravascular thrombosis was a major problem causing serious damage to brain, kidneys, and intestine, and 9 deaths. Mustard's operation produced immediate improvement but the long-term prognosis has still to be assessed.