Creation of an atrial septal defect in transposition of the great vessels.

نویسنده

M S Gotsman

چکیده

Four-fifths of the infants with transposition of the great vessels die within the first year of life (Abbott, 1936). Fifty-two per cent. die within the first month and 86% are dead within six months (Keith, Neill, Viad, Rowe, and Chute, 1953). This lesion in some form occurs in 20% of necropsies on patients with congenital heart disease (Keith, Rowe, and Vlad, 1958). In Birmingham, transposition of the great vessels is the commonest form of cyanotic congenital heart disease in patients admitted to the neonatal cardiac unit. The outcome is frequently fatal. The prognosis is worse if a ventricular septal defect is absent (Noonan, Nadas, Rudolph, and Harris, 1960) and the atrial septal defect is small (Mustard, Keith, Trusler, Fowler, and Kidd, 1964). Any form of therapy is therefore useful if it can prolong life until the patient has grown sufficiently to benefit from corrective sur.gery. Hanlon and Blalock (1948) and Fontana and Edwards (1962) found that the duration of survival is longest when both atrial and ventricular septal defects are present. The creation of an atrial septal defect therefore appears to be a rational form of palliative therapy (Ochsner, Cooley, Harris, and McNamara, 1961 Mustard, 1964; Mustard et al., 1964; Trusler, Mustard, and Fowler, 1964). Unfortunately, no detailed haemodynamic reports are available to indicate the effectiveness of creating an atrial septal defect, since cardiac catheterization in this group of patients is difficult and dangerous. We shall describe the findings at cineangiocardiography before and after the creation of an atrial septal defect in a seriously ill neonate who improved after operation.

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