Palliative Senning in the Treatment of Congenital Heart Disease with Severe Pulmonary Hypertension

Background

Transposition of the great arteries (TGA) is the most common cyanotic cardiopathy,with an incidence ranging between 0.2 and 0.4 per 1000 live births. Many patientsnot treated in the first few months of life may progress with severe pulmonaryvascular disease. Treatment of these patients may include palliative surgery toredirect the flow at the atrial level.

Objective

Report our institutional experience with the palliative Senning procedure inchildren diagnosed with TGA and double outlet right ventricle with severepulmonary vascular disease, and to evaluate the early and late clinicalprogression of the palliative Senning procedure.

Methods

Retrospective study based on the evaluation of medical records in the period of1991 to 2014. Only patients without an indication for definitive surgicaltreatment of the cardiopathy due to elevated pulmonary pressure were included.

Results

After one year of follow-up there was a mean increase in arterial oxygensaturation from 62.1% to 92.5% and a mean decrease in hematocrit from 49.4% to36.3%. Lung histological analysis was feasible in 16 patients. In 8 patients,pulmonary biopsy grades 3 and 4 were evidenced.

Conclusion

The palliative Senning procedure improved arterial oxygen saturation, reducedpolycythemia, and provided a better quality of life for patients with TGA withventricular septal defect, severe pulmonary hypertension, and poor prognosis.