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Repairing transposition of the great arteries: history of the challenge
  1. Magdalena Mazurak,
  2. Jacek Kusa
  1. Department of Pediatric Cardiology, Regional Specialist Hospital, Research and Development Center, Wroclaw, Poland
  1. Correspondence to Dr Magdalena Mazurak, Department of Pediatric Cardiology, Regional Specialist Hospital, Research and Development Center, Wroclaw 51-124, Poland; madzia-mazurak{at}wp.pl

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Introduction

Transposition of the great arteries (TGA) was first discussed by Matthew Baillie in 1797 in ‘The Morbid Anatomy of Some of the Most Important Parts of the Human Body’.1 However, the term ‘transposition’ was not used within this context until 1814, when Richard John Farre, in his ‘Pathological Researches on Malformations of the Human Heart’, described the position of the aorta and pulmonary trunk.2

The Blalock-Hanlon procedure

Until the 1950s, TGA was considered a lethal anomaly. Alfred Blalock and Rollins Hanlon, with technician Vivien Thomas, performed at the Johns Hopkins Hunterian Laboratory a series of animal experiments aimed at redirecting venous blood flow inside the atria. The result was the creation of a large atrial septal defect (ASD) by excision of the atrial septum for adequate mixing of blood. In 1950, Blalock and Hanlon published a description of—a surgically created ASD, known today as the Blalock-Hanlon procedure.3 Later, surgical atriosepectomy was replaced by an palliative intervention called the Rashkind procedure, which was first decribed in 1966 by Rashkind and Miller.4 Balloon atrioseptostomy carried a lower risk and was equally effective.

Venous switch

In 1953, Lillehei and Varco (University of Minnesota) reported their attempts at surgical correction of TGA.5 In the first four infants, they anastomosed the right pulmonary veins to the right atrium—the survival rate was 50%. In the subsequent four patients, they added a second anastomosis between the inferior vena cava and the left atrium. Unfortunately, all of the children died.

Thomas Baffes reported his first successful ‘venous switch’ in a human in 1956.6 Baffes used aortic homografts …

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