77 ASSESSMENT OF CORONARY AND AORTIC ANASTOMOSES FOLLOWING ANATOMIC CORRECTION OF TRANSPOSITION OF THE GREAT ARTERIES

Abstract

Anatomic correction of transposition of the great arteries (TGA) is usually done at a young age and always entails circumferential anastomoses of the aorta and coronary arteries. Longterm success of this procedure is predicated on adequate growth of these anastomotic sites. To assess these anastomoses, 25 patients (pts) underwent one or two cardiac catheterizations frcm 1 to 53 months (mean 18.8 months) following anatomic correction. Early catheterizations (mean 12 months following repair) were performed in 23 pts and late studies (mean 30 months following repair) in 13. Age at repair ranged from 2 to 168 months, and 15 pts were less than one year of age. Fifteen pts had undergone previous pulmonary artery banding in preparation for anatomic repair. Five distinct aortic diameters were measured on AP and lateral angiograms. Measurements were made at the anastomotic site, proximal, and distal to the anastomosis. Nearly all diameters of the aorta were larger than control values. There were no differences in early and late postoperative measurements. There were no differences when previously banded pts were compared to non-banded pts. No patient had a pressure gradient measured across the aortic anastomosis. Subjective examination of the coronary arteries showed no areas of kinking, narrowing or tortuosity and there was never ECG evidence of ischemia.

We conclude that coronary and aortic anastomoses allow for satisfactory growth following anatomic correction of TGA even when there has been prior pulmonary artery banding. The large ascending aorta does not appear to undergo progressive dialation following anatomic correction.

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