Traitement chirurgical de la transposition complète des gros vaisseaux

Among congenital heart defects, transposition of the great arteries is a frequent lesion. It includes an abnormal ventriculo arterial connection, the aorta arising from the right ventricle and the pulmonary artery from the left ventricle. To this basic anotomic and physiologic condition, several intra and/or extra cardiac lesions may be associated. Without any intervention, it is quickly lethal. Early- and long-term prognosis has been thoroughly modified by the introduction of the arterial switch operation. This latter consists in reestablishment of normal anatomic ventriculo arterial connections, the aorta and coronary ostia arising from the left ventricle and the pulmonary artery from the right ventricle. In general and depending on the anatomic and clinical status, associated lesions are repaired during the same operative procedure. The single risk factor for operative mortality is the anatomy of coronary patterns to be transfered in aortic position. Early- and long-term results are excellent with 5% of early mortality and a 15 years survival rate close to 90%. At follow up, the vast majority of patients have a normal life without any medication. Three levels of postoperative complications can occur: right ventricular outflow tract obstruction, aortic valve insufficiency and myocardial ischemia due to coronary ostial stenosis. All these complications mandate a regular cardiologic follow-up.