From 1985 through 1994, 12 consecutive patients with Taussig-Bing anomaly underwent an arterial switch. Age at operation varied from 8 to 42 months (mean 21 months). Coarctation of the aorta was present in 6 patients (including 4 with hypoplasia of the aortic arch), interruption of the aortic arch in one, straddling mitral valve in one and subaortic stenosis in two. The relationship of the great arteries was D-transposition in 11 patients (oblique in 6 and anteroposterior in 5) and side-by-side in one. Eleven patients had previous palliative surgery. Pulmonary artery banding was done in 11 patients, Blalock-Hanlon in 3, carotid flap aortoplasty in 3, subclavian flap aortoplasty in 2, extended aortic arch anastomosis in 2 and ligation of PDA in 1. The Lecompte maneuver was adopted in all but one patient with side-by-side great vessels. Intraventricular reconstruction was done through the right ventricle in 11 patients and through the right atrium in one who underwent one-stage repair. There was one early death, which was related to thrombosis of the superior mesenteric artery. One patient with side-by-side great vessels died at home 6 months after the arterial switch operation. The suspected cause of death was myocardial infarction due to compression of the left coronary artery by the pulmonary artery. In the follow-up of 10 patients ranging from 1.8 to 9.4 years (average 6.3 years), one required reoperation for pulmonary stenosis. We conclude that two-staged arterial switch operation of Taussig-Bing anomaly with D-transposition can be performed with low mortality, but there seems to be some risk of the compression of the left coronary artery in the original Jatene method for Taussig-Bing anomaly with side-by-side great vessels.

Infants with complete atrioventricular canal (CAVC) and severe congestive heart failure, not responding to medical managements, presents a difficult management problem. Between December, 1980, and August, 1987, 16 infants with CAVC presenting severe congestive heart failure underwent pulmonary artery banding. Average age at operation was 1.7 months (0.5 to 4) and average weight was 3.5kg (2.5∼4.9). Only four patients were older than 3 months of age at operation. Pre-operative cardiac catheterization and echocardiogram demonstrated that seven patients had mild to severe left atrioventricular valve regurgitation. Hospital death occurred in one patient (6%) due to rupture of the pulmonary artery. Of three late deaths, one patient had congestive heart failure, and one patient complicated with partial obstruction of right pulmonary artery died suddenly of an upper respiratory infection 11 months after rebanding. Survivors have been followed 18 to 94 months and all patients are growing at an increased rate postoperatively. In five patients of 12 long-term survivors who have undergone cardiac catheterization 37 to 83 months after the operation, pulmonary/systemic systolic pressure ratio (PP/PS) were 0.2∼0.42 (average 0.28). It is concluded that the pulmonary artery banding in infants with CAVC can be performed with low operative and late mortality and can provide good relief of symptoms and allow normal growth and development. It should be emphasized that early surgical palliation is mandatory to prevent the development of pulmonary hypertension and pulmonary emphysematous change.

The cases of neonates and infants who underwent successful delayed sternal closure (DSC) using silastic rubber after open heart surgery were reviewed. The indication for DSC was cardiac dilatation with tamponade-like behavior upon attempted sternal closure in all. In 7 of 10 cases, DSC were possible within 4 days after operation. There were statistical decrease in heart rate (HR), left atrial pressure (LAP), cardiothoracic ratio (CTR) and inspiratory oxygen concentration of the respirator at the time of DSC compared to those in the early postoperative period. None of the patients had mediastinitis or other severe infection in the postoperative course. One patient each died of progressive pulmonary venous obstruction and of non-cardiac disease late postoperatively and 8 patients are long-term survivors. It is concluded that DSC is recommended whenever there is any hemodynamic deterioration due to attempted sternal closure following open heart surgery in infancy as it could be safely performed within 3 to 4 days after operation without any complication.