Indication for total correction of complete transposition of the great arteries with pulmonary hypertension.

Pulmonary vascular disease (PVD) was histologically evaluated and its severity was expressed as an index of PVD in 14 autopsied and eight biopsied cases of complete transposition of the great arteries (TGA) in patients more than 6 months of age. The index varied from 1.0 to 2.3 in six patients who had survived complete surgical repair and ranged from 2.3 to 3.3 in five patients who had died of PVD postoperatively. Consequently, an index of 2.2 could be regarded as an upper limit of PVD for complete surgical repair. The index was significantly correlated to some hemodynamic factors. From the regression equation, the value 2.2 of histologic index could be translated into the clinical factors concerning hemodynamics. We consider that patients with pulmonary vascular resistance of less than 10.6 units . m2, and pulmonary arterial mean pressure less than 51 mm Hg, are suitable candidates for complete surgical repair in TGA, if more than 6 months of age. Thus histologic assessment of PVD in a lung biopsy as an indication for total correction of TGA with pulmonary hypertension appears to be useful in patients who are in borderline hemodynamic condition or in whom the hemodynamics could not be evaluated although pulmonary hypertension was suspected.