Ligation of the Main Pulmonary Artery and Systemic-Pulmonary Arterial Anastomosis

THE MANAGEMENT of complete transposition of the great arteries remains one of the most challenging problems in the operative treatment of congenital heart disease. Although a completely corrective operation is feasible,1 2 in most centers the mortality associated with this procedure is prohibitive, and it is likely to remain high among the seriously ill infants who form the vast majority of patients with this malformation. While total correction is technically less difficult in older children, the presence of serious and possibly irreversible changes in the pulmonary vascular bed may limit the effectiveness of the procedure in this age group as well. Instead of a corrective operation, therefore, surgeons have most commonly utilized a palliative procedure for complete transposition of the great arteries; these operations include creation or enlargement of an atrial septal defect in order to improve mixing between the two circulations,3 establishment of a systemic-pulmonary artery anastomosis or superior vena cava-pulmonary artery anastomosis to increase pulmonary blood flow,4'5 banding of the pulmonary artery or closure of a patent ductus arteriosus or both to reduce pulmonary blood flow,6' 7 inferior vena caval-left atrial anastomosis with transplantation of the right pulmonary veins,8 and various combinations of these procedures.9 The purpose of this report is to describe the rationale of a new palliative operative