A simple method of perfusion for refashioning the intraatrial baffle after physiological correction of transposition of the great vessels

Superior vena cava obstruction after Mustard repair of d-transposition of the great arteries

Superior vena caval obstruction following Mustard repair of d-transposition of the great arteries is usually relieved by partial or complete revision of the intra-atrial repair. We employed a different approach in a patient with isolated total obstruction of the superior vena caval pathway, who suffered from fatigue, venous congestion in the upper part of the body and mild hydrocephalus. A 12 mm polytetrafluoroethylene tube was interposed between the left innominate vein and the left (functionally right) atrial appendage. Early and medium-term relief was demonstrated by repeat catheterization of the right heart and computed tomography brain scan three months postoperatively. The rationale for use of prosthetic material in the venous system is discussed and the need for long-term follow-up is stressed.

Prefabricated Dacron baffle for use in correction of transposition of the great arteries

Interatrial venous transposition for correction of transposition of the great arteries (TGA) is facilitated by using a premolded Dacron baffle. Fine-mesh Dacron is easily fashioned to the desired shape in a metallic brass mold at 200 degrees C. The resultant baffle material can be autoclaved without losing its shape or altering the fabric characteristics of flexibility and porosity. This premolded baffle has been used in our last 7 patients with TGA over the past two years without complication, and the use of Dacron in 13 survivors over the past seven years has shown no pulmonary or venous obstructions related to the material.

Late development of pulmonary venous obstruction following Mustard's operation using a dacron baffle

Three patients developed late pulmonary vein obstruction (PVO) following Mustard's operation for transposition of the great arteries. In all three the absence of PVO had been documented by an earlier postoperative cardiac catheterization. At reoperation shrinkage and kinking of the dacron baffle was evident. After Mustard's operation, patients should be observed closely for symptoms and signs of PVO since it can occur insidiously despite previously proven absence of this complication.