Current surgical correction of DORV with subpulmonary VSD (Taussig-Bing Heart) includes complete intraventricular repair versus the Arterial Switch Operation (ASO) and septal alignment of the left ventricle to the pulmonary outflow.
A uniformed approach has been adopted in our unit since 1991, using the ASO in 15 consecutive patients with TBH, regardless of anatomic variability.
The great vessels were anteroposterior in 9 patients and side-by-side in 6. Three patients had a second VSD and 4 patients had coexistent aortic coarctation and/or arch hypoplasia.
Coronary artery anatomy was unusual in 2 patients. Five children had an abnormal delineation of tricuspid chordae.
Previous surgery included pulmonary artery banding (2) and coarctation repair (3) in 4 patients. The median age at the time of the ASO was 2 months (12 days - 4 years).
Surgical technique evolved to include:
– transarterial LV to PA rerouting
– modified ASO using the Lecompte manoeuvre
– RVOT reconstruction with a large trapezoidal autologus pericardial patch
Surgical outcome resulted in 2 early deaths, including 1 early reoperation. Two patients needed late reoperation. LV function is normal in all patients. Three patients have mild neoaortic valve regurgitation and 8 patients mild to moderate neopulmonary incompetence.
Two patients present a L-sided and 3 patients a R-sided gradient.
In conclusion, the short-term results of the ASO in TBH are at least as good as these of the intraventricular repair, but the ASO has the advantage of being more suitable to early, even neonatal correction with or without concomitant coarctation repair.
However, further follow-up is needed to assess the benefit of early surgery on pulmonary vascular hemodynamics, LV function, sigmoid valve function and the occurrence of LVOT and RVOT obstruction.