Summary
Since March 1978, 59 patients with transposition of the great arteries (TGA) ranging
in age from 2 months to 6 years have undergone the Senning operation. Forty-six patients
(77.9%) had transposition with intact ventricular septum, 8 of them with patent ductus
arteriosus; 8 patients (13.5%) had TGA with ventricular septal defect (VSD), 3 of
them with previously performed banding; 4 patients (6.7%) had TGA with VSD and pulmonary
stenosis (PS), and one (1.6%) had TGA with PS. Prior to correction, 38 cases had undergone
a Rashkind septotomy and 15 had had a previous Blalock-Hanlon septectomy.
During this time we have introduced some technical modifications of the original Senning
operation: (A) right atrial incision, (B) large left atrial wall window, (C) infrasinal
suture of the left atrial flap, (D) avoidance of damage to the hypothetical anterior
atrioventricular conduction bundle, and recently, in 12 patients, we have used (E)
an inverted left atrial appendage as an interatrial flap.
There were 9 hospital deaths (15.2%) caused by low cardiac output (4 cases), severe
hypoxemia and low cardiac output (4 cases) and one patient with pulmonary venous drainage
obstruction died following reoperation. Two patients developed neurological complications
that disappeared without sequela, Another complication was a right chylothorax (4
patients), which improved without the necessity of surgical repair. Eighteen patients
developed a junctional rhythm for a period over 24 hours.
We think that the technical modifications which we present here, partially contribute
to improving the Senning operation.
Key words
Transposition of the great arteries - Senning operation - Technical considerations
