Double outlet right ventricle with pulmonic stenosis and anteriorly positioned aorta(Taussig-Bing variant). Report of a case and surgical correction

Taussig-Bing anomaly and coarctation of the aorta in infancy: surgical options

The coexistence of the Taussig-Bing anomaly and coarctation of the aorta is a highly complex situation carrying a dismal prognosis. Through our experience and a review, we have observed that neonates requiring coarctation repair, pulmonary artery banding, and patent ductus ligation are at high risk of expiring before reaching an age at which a difficult total repair is feasible. It appears that patients presenting beyond the neonatal period have a better chance of surviving an initial surgical procedure and the definitive repair. A surgical management protocol has been suggested. Although associated with an uncertain late prognosis, arterial level repairs are the most physiologic, and their results to date are encouraging.

Transatrial repair of double-outlet right ventricle in infants

In three infant cases of double outlet right ventricle (DORV), two with normally related great arteries (NGA) and one with side-by-side great arteries, a transatrial repair was carried out. In all three cases, the results were excellent. It is concluded that in the small baby with DORV with NGA and in DORV with side-by-side great arteries with a hypoplastic crista, a transatrial repair should be successful. This is dependent on the VSD being in the perimembranous (and, therefore, subaortic) location and on the absence of infundibular pulmonary stenosis. In all other varieties of DORV the repair should probably be done through the ventricle.

Taussig-Bing anomaly: total repair with closure of ventricular septal defect through the pulmonary artery

Total surgical repair of a Taussig-Bing malformation in an 8-year-old boy was accomplished successfully after previous palliative procedures. The child had undergone a Rashkind septostomy when he was 10 days old, banding of the pulmonary artery and division of a patent ductus arteriosus when he was 2 weeks old, and a Blalock-Hanlon septectomy when he was 1 year old. Complete repair involved patching the ventricular septal defect (VSD), debanding and patching the pulmonary artery, and rerouting the venous return by performing a Mustard procedure. Because of its high location, the VSD could not be reached properly through the tricuspid valve and was approached through the pulmonary arteriotomy. Excellent exposure was obtained by retracting the pulmonary valve, and patch closure of the defect was achieved without difficulties. We believe this approach to the VSD is preferable because no incision is necessary in the right ventricle. This is important since the right ventricle becomes the systemic ventricle after the Mustard operation.

Successful intracardiac repair of the Taussig-Bing malformation in 2 children

Surgical repair of the Taussig-Bing deformity has been successful in 2 children weighting 7.7 and 11.1 kg, respectively. In the first case the right ventricular patch divered left ventricular blood to the pulmonary arter, thus creating a physiologically complete transposition which was then corrected by an interatrial Mustard baffle. In the second case a right ventricular tunnel diverted left ventricular blood to the aorta, and right ventricular blood was directed to the distal pulmonary artery by means of an external conduit bypassing a subpulmonic stenosis. These patients represent the seventh and eighth successful corrections of the Taussig-Bing anomaly. One case (Patient 2) is the youngest to undergo repair and the first to receive an external conduit for bypass of an associated subpulmonic stenosis.

The conduction system in double outlet right ventricle with subpulmonic ventricular septal defect and related hearts (the Taussig-Bing group)

The Taussig-Bind group of hearts is that group in which the aorta emerges completely from the right ventricle, unrelated to the position of the ventricular septal defect (VSD), while the pulmonary trunk emerges at varying degrees from the right ventricle related to the location of the VSD. Several types of surgical procedures involve the VSD in these hearts. The conduction systems in six of these hearts were therefore studied. The atrioventricular (A-V) bundle lies in the inferior (posterior) wall of the defect on the left side beneath the summit of the ventricular septum. In some cases, the bundle may be proximal to the defect, thus lying intramuscularly, and only the right and left bundle branches are related to the defect. The pattern od development of the atrioventricular (A-V) node, bundle and bundle branches is related primarily to the development of the endocardial cushions and posterior ventricular septum, and not to that of the absorption of the bulbus.