Scientific Online Resource System

Scripta Scientifica Medica

Complete transposition of the great arteries - surgical results and prognosis

Petar Shivachev, Lachezar Marinov, Margarita Tzonsarova, Dobrinka Radoinova


Objectives: The aim of this study was to analyze the surgical results and the prognosis in patients with complete transposition of the great arteries (TGA).

Study design: A group of 64 children with complete TGA out of 272 patients with critical congenital heart disease (CCHD) from the region of North-East Bulgaria was retrospectively followed for a period of 25 years (1987-2011 year). Methods of investigations include: clinical examination, electrocardiography, conventional radiography, echocardiography and cardiac catheterization. Surgical results were based on a scale, elaborated by us.

Results: Complete TGA is the most frequent CCHD in the region of North-East Bulgaria - 23%, and in 64.1% of the cases it was associated with other cardiac malformations. Surgical correction was performed in 41 of the children (64.1%) with TGA - an average 2.17 interventions on each patient. The overall postoperative mortality rate was 43.9% and it was highest if concomitant lesions were presented, such as pulmonary stenosis or atresia, criss-cross atrioventricular connection and others - up to 50-60%. The balloon atrioseptostomy was the most common initial palliative procedure, performed in 83% of the newborns at a mean age of 7.1days and a mortality rate - 8.8%. In 31 of the children (75.6%) a complete corrective intervention was made. The most frequent was arterial switch operation (ASO) - 16 children (51%). Six of the children died - 37.5%, but the mean age of which the surgery was performed was significantly higher - 32.2 days in contrast to 16.8 days for the whole group (p<0.05). The surgical results on the 5th year were assessed as good/very good in 4 of the children and satisfactory in 1 child. Senning procedure was performed in 8 of the patients (26%) with a mortality rate of 25%. Four of the children (13%) undergone Rastelli or REV procedure and 3 of them (10%) had one-chambered Fontan procedure.

Conclusions : Complete TGA is the most frequent CCHD. The associated cardiac malformations have significant influence upon the prognosis and the surgical results. On different reasons still significantly high number of children with TGA remains without corrective interventions. The fundamental corrective procedure is ASO and the delayed intervention leads to unsatisfactory postoperative results.

Full Text


Angeli E, Raisky O, Bonnet D, et al. Late reoperations

after neonatal arterial switch operation for

transposition of the great arteries. Eur J Cardiothorac

Surg 2008;34:32-6.

Campbell M. Natural history of cyanotic malformations

and comparison of oll common cardiac

malformations. Br Heart J. 1972;34(1):3-8.

de Koning WB, van Osch-Gevers M, Harkel AD,

et al. Follow-up outcomes 10 years after arterial

switch operation for transposition of the great

arteries: comparison of cardiological health status

and health-related quality of life to those of

the a normal reference population. Eur J Pediatr


Dos L, Teruel L, Ferreira IJ, et al. Late outcome

of Senning and Mustard procedures for correction

of transposition of the great arteries. Heart


Lee JR, Lim HG, Kim YJ, et al. Repair of transposition

of the great arteries, ventricular septal defect

and left ventricular outflow tract obstruction. Eur J

Cardiothorac Surg 2004;25:735-41.

Liebman J, Cullum L, Belloc NB. Natural History

of Transposition of the Great Arteries. Circulation


Lin AE, Di Sessa TG, Williams RG. Balloon

and blade atrial septostomy facilitated by twodimensional

echocardiography. Am J Cardiol


Losay J, Touchot A, Serraf A, et al. Late Outcome

After Arterial Switch Operation for Transposition

of the Great Arteries. Circulation 2001;104:121-6.

Martins P, Castela E. Transposition of the great arteries.

Orfanet J of Rare Disease 2008,3:27.

Martins P, Tran V, Price G, et al. Extending the

surgical boundaries in the management of the

left ventricular outflow tract obstruction in discordant

ventriculo-arterial connections - a surgical

and morphological study. Cardiol Young


Moons P, Gewilling M, Sluysmans T, et al. Long

term outcome up to 30 years after the Mustard or

Senning operation: a nationwide multicentre study

in Belgium. Heart 2004;90:307-13.

Perry LW, Ruckman RN, Galioto FM Jr, et al. Echocardiographically

assisted balloon atrial septostomy.

Pediatrics 1982;70:403-8.

Samánek M, Slavik Z, Zborilová B, et al. Prevalens,

treatment, and outcome of heart disease in liveborn

children: a prospective analysis of 91,823 liveborn

children. Pediatr Cardiol 1989;10:205-11.

Thanapoulos BD, Georgakopoulos D, Tsaousis GS,

Simeunovic S. Percutaneous balloon dilatation of

the atrial septum: immediate and midterm results.

Heart 1996;76:502-6.

Vouhé PR, Tamisier D, Leca F, et al. Transposition

of the great arteries, ventricular septal defect

and pulmonary outflow tract obstruction. Rastelli

or Lecompte procedure? Thorac Cardiovasc Surg




Article Tools
Email this article (Login required)
About The Authors

Petar Shivachev
Medical University of Varna

Clinic of Pediatrics

Lachezar Marinov
Medical University of Varna

Clinic of Pediatrics

Margarita Tzonsarova
National Hospital of Cardiology - Sofia, Bulgaria

Department of Pediatrics and Pediatric Cardiology

Dobrinka Radoinova
Medical University of Varna

Department of Pathology and Forensic medicine

Font Size