The double-switch procedure for atrioventricular and ventriculoarterial discordance

Late ventricular failure remains a major concern in patients with congenitally corrected transposition of the great arteries (ccTGA). A new treatment for this condition is the double-switch procedure.

Three consecutive children with atrioventricular and ventriculoarterial discordance (congenitally corrected transposition of the great arteries) and associated ventricular septal defect underwent pulmonary artery banding in infancy, followed by a double-switch procedure and closure of the ventricular septal defect at a median age of 5.8 years (range 4.5 to 6 years).

There were no major procedure-related complications and the median duration of hospital stay was 13 days. One patient required stent implantation in the superior vena cava five months after surgery to relieve a persistent caval stenosis associated with recurrent pleural and pericardial effusions. Apart from this, no other complications have occurred over a median follow-up of five months.

The double-switch procedure offers the potential advantage of restoring the morphological left ventricle to systemic ventricle. Longer-term follow-up of this procedure is warranted.