Transaortic closure of ventricular septal defect in patients with corrected transposition with pulmonary stenosis or atresia.

In 12 patients having corrected transposition with pulmonary stenosis (n = 8) or atresia (n = 4), the associated ventricular septal defect was repaired transaortically. Ages ranged from 4 to 50 years (mean 14.3). The hemoglobin ranged from 13.2 to 22.4 g/dl (mean 16.6), the hematocrit ranged from 40.2% to 68.2% (mean 49.0%), and the arterial oxygen saturation ranged from 63% to 97% (mean 83.8%). Associated anomalies included atrial septal defect (n = 11), double-outlet right ventricle (n = 7), dextrocardia (n = 4), and mesocardia (n = 2). Ten patients received an extracardiac conduit. There were two in-hospital deaths from low cardiac output. None of the 10 survivors had complete heart block, residual ventricular septal defect, aortic incompetence, or coronary arterial injury. Transaortic closure of ventricular septal defect is preferred in corrected transposition because it minimizes complete heart block (the conduction system courses subendocardially in the pulmonary ventricle), allows secure placement of the patch (on the high-pressure side of the defect), and limits coronary arterial and anterior papillary muscle injury (the pulmonary ventriculotomy for conduit anastomosis may be made in an apical location).