Complex Transposition

Transposition with ventricular septal defect and Transposition with persistent arterial duct.

In both these conditions, there is a large communication between the two separate circulations.

Despite this, most centres would advise making an additional hole between the two receiving chambers (balloon septostomy) by a catheter. The children are frequently only moderately blue but very breathless. They need medications to support their heart and require early surgery. Repair involves switching the arteries back to normal, re-implanting the coronary arteries and closing the communication. This is a large operation requiring open heart surgery and is usually undertaken in the first weeks of life to prevent damage occurring to the lung arteries. Occasionally, banding or narrowing is put on the lung artery if the communication is particularly difficult to close, and open surgery thus delayed.

Transposition with ventricular septal defect and pulmonary stenosis.

The lungs are protected by the narrowing between the heart and the lung artery. The hole between the two pumping chambers allows the two streams of blood to mix, and therefore, these children are not as blue as those with simple transposition. However, as the months go by, the obstruction to blood flow increases, and a shunt procedure and enlarging of the atrial hole is frequently required.

The obstruction between the heart and the lung arteries is difficult to relieve directly and usually has to be bypassed by a valved artificial tube (a conduit) placed between the right ventricle and the lung artery. The hole between the pumping chambers is closed so that the left pump chamber directs blood into the aorta. This operation is often postponed until the children are four to six years of age to allow an adequate sized tube to be inserted.

This is a major operation requiring open heart surgery, and is often referred to as a Rastelli procedure. As the tubes implanted at the operation do not allow for growth, they get relatively narrower and often need replacing in later life.

Long term follow-up and antibiotic prophylaxis is required.

Transposition with VSD persistent duct and ASD

Victoria & Tasmania