Surgical transposition of the atria: A new procedure for repairing transposition of the great vessels.

The proposed procedure consists of interchanging the positions of the atria by means of an incision used in heart transplantation. After frontal sectioning of the atrial body, the heart is turned up on its pedicle, the interatrial septum is divided in its posterior part, and the vena cavae are extensively freed from their mediastinal and diaphragmatic attachments. The posterior parts of the atria can then be transposed: the right atrium and vena cava are repositioned to the left of the left atrium, and a new septum is constructed by joining the external atrial walls. The heart can then be replaced and the walls of the transposed atria repaired by edge-to-edge sutures. Cadaver experiments have indicated that this procedure is applicable in infants and young people. Casts and radiologic examinations have shown no strictures in the vena cavae, and the possibility of postoperative arrhythmias has been evaluated by means of electrocardiographic studies in dogs surviving for long periods after heart autotransplantation.