Subscribe to RSS
DOI: 10.1055/s-2007-967678
Double switch procedure, the anatomic correction of the congenitally corrected transposition of the great arteries
Aims: Congenitally corrected transposition of the great arteries (cTGA) is a rare defect characterized by discordant atrioventricular and ventriculoarterial connections. Correction of the associated defects alone and leaving the morphologic right ventricle in systemic position is a low risk procedure, but can negatively affect the patient's long-term prognosis. Anatomic repair by double switch technique (complicated procedure) may improve survival of patients by establishing the morphologic left ventricle in the systemic circulation.
Aim: To present changes in our surgical strategy of cTGA between 1975–2005.
Methods: 66 palliative and corrective cardiac surgical procedures were performed on 44 children with an early mortality of 7.5%. Types of surgery included pacemaker implantation (11), palliative procedures (26), „one-ventricle repair“ (12), correction of the associated cardiac defects (15), anatomic correction (2). Follow-up period ranged from 1–30 (mean 14) years, late mortality occurred in 2 patients (with right ventricular dysfunction). The experiences from the managements of 176 Senning and 168 Jatene procedures helped us to perform the anatomic correction of the cTGA. We would like to present a case of a 2.5-year-old girl (7kg) with cTGA, VSD, previous palliative procedure, who was corrected by double switch technique and patch closure of VSD. 17 months after the operation the girl is doing well without any medication.
Conclusions: Anatomic correction in infants or small children provides the best long-term results and should be the first surgical choice. If anatomic conditions are not suitable for total correction, the associated defects will determine the type of the surgical procedure.
Keywords: double switch, congenitally corrected transposition of the great arteries