Combined atrial and arterial switch operations for congenitally corrected transposition

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Conventional repair of congenitally corrected transposition of the great arteries (CCTGA) places the right ventricle in a systemic position, potentially leading to long-term complications.
• These complications include right ventricular dysfunction, tricuspid regurgitation, and conduction system failure.

Observation:

• Two pediatric patients with CCTGA, one with apicocaval juxtaposition, underwent successful combined atrial and arterial switch procedures.
• This represents the first reported successful completion of this surgical approach in Taiwan.

Findings:

• Anatomic repair of CCTGA demonstrated lower early and late mortality and reduced incidence of complete heart block compared to conventional repair.
• In cases with apicocaval juxtaposition, specific surgical strategies like the Mustard operation or one-and-a-half ventricular repair combined with Rastelli-type repair may be beneficial.
• Left atriotomy provides excellent access to the ventricular septal defect via the tricuspid valve.

Implications:

• Anatomic repair of CCTGA is superior to conventional methods in preserving the function of the systemic right ventricle, tricuspid valve, and conduction system.
• These findings support the consideration of anatomic repair for improved long-term outcomes in CCTGA patients.
• Mandatory long-term follow-up is crucial for monitoring patients after CCTGA repair.