Palliative switch: a surgical decision after hybrid procedure

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Neonatal Intensive Care

Background:

• Single-ventricle anatomy with transposed great arteries presents complex surgical challenges.
• Systemic ventricular outflow and aortic arch obstruction complicate initial palliation, often necessitating a Norwood procedure.

Observation:

• A newborn with double inlet left ventricle, discordant ventriculoarterial connection, restrictive ventricular foramen, and severe aortic arch obstruction was treated.
• Initial management involved a hybrid procedure to stabilize hemodynamics.
• A palliative arterial switch procedure was performed three months later as an alternative to the Norwood-Glenn procedure.

Findings:

• The hybrid procedure effectively addressed hemodynamic instability in the neonate.
• Palliative arterial switch combined with arch reconstruction proved to be a viable alternative surgical strategy.
• This approach offers a novel solution for complex congenital heart disease cases.

Implications:

• Palliative arterial switch with arch reconstruction provides an effective alternative for complex neonatal cardiac surgical cases.
• This strategy may improve outcomes for infants with challenging single-ventricle physiology and associated obstructions.
• Further research into this surgical approach is warranted for complex congenital heart disease management.