Copyright © 1997 by the European Society of Cardiology.
© 1997 The European Society of Cardiology
The double switch procedure for anatomical repair of congenitally corrected transposition of the great arteries in infants and children
Divisions of Cardiothoracic Surgery and Pediatric Cardiology, University of California San Francisco, California, U.S.A.
revised 4 February 1997; accepted 24 February 1997.
Correspondence: V. Mohan Reddy, MD, 505 Parnassus Avenue, M593, San Francisco, CA 94143 0118 U.S.A.
Abstract
AIMS: To assess outcomes of anatomical repair (double switch procedure) in infants and children with congenitally corrected transposition of the great arteries.
METHODS AND RESULTS: Between September 1993 and August 1996, 17 patients with congenitally corrected transposition underwent surgery at UCSF. Anatomical repair was performed in 11 of these patients, at ages ranging from 4·8 months to 7·8 years (median 3·2 years). The remaining six patients did not undergo anatomical repair due to unfavourable anatomy (n=2), prior conduit repair (n=2), biventricular dysfunction (n=1), and isolated complete atrioventricular block (n=1). The 11 patients who underwent anatomical repair make up the study group for the present report. All 11 patients had a malalignment ventricular septal defect, while pulmonary outflow tract obstruction was present in nine patients and significant tricuspid valve pathology or dysfunction was present in five. Anatomical repair was achieved with a Senning (n=7) or a Mustard (n=4) procedure combined with an arterial switch operation plus ventricular septal defect closure (n=4), or a Rastelli procedure with left ventricle to aortic baffle and right ventricle to pulmonary artery conduit (n=7). There was one early death and no patients developed surgical complete atrioventricular block. At a median follow-up of 22 months, there were no late deaths. Two patients required a total of three late reoperations, and all patients were asymptomatic on no cardiac medication. Follow-up echocardiography revealed normal biventricular function in all patients.
CONCLUSIONS: Anatomical repair of corrected transposition can be achieved with low rates of early mortality and surgical heart block, and favourable mid-term results. Long-term follow-up will be necessary to determine if the double switch approach improves the natural history of corrected transposition when compared to less aggressive surgical approaches that leave the right ventricle in the systemic circulation.
Key Words: Atrioventricular discordance • ventriculoarterial discordance • Rastelli procedure • arterial switch operation • Senning operation • Mustard operation
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