An experience of rapid, two-stage arterial switch operation for transposition of the great arteries and intact ventricular septum beyond the neonatal period]

A 2-month-old girl with transposition of the great arteries and intact ventricular septum was successfully repaired by rapid, two-stage arterial switch operation. Balloon atrioseptostomy and ligation of the ductus arteriosus was done elsewhere on 14th and 29th day after birth. On her first admission to our hospital at 2 months of age, left ventricular-right ventricular pressure ratio (LVp/RVp) was almost 0.5 and left ventricular posterior wall thickness (LVPWT) by echo cardiography was 3.5 mm. Because of these date, we selected rapid, two-stage arterial switch operation. On 74 days, the first-stage preparatory operation (pulmonary arterial banding and right modified Blalock-Taussig shunt) was undergone with the resultant LVp/RVp of 0.97. During a few days after the first-stage operation, left ventricular ejection fraction (LVEF) by echocardiography was reduced to nearly 30%. But after this phase left ventricular function recovered rapidly and LVp/RVp, LVPWT and LVEF was 1.18, 6.3 mm and 66% on the 7th day. On the 9th day, the second-stage arterial switch operation was undergone as usual as in neonatal period without hard adhesion. Her postoperative course was uneventful.