How I Do It: Modified Senning Double Switch For Criss-Cross Heart With AV/VA Discordance.

Area of Science:

• Congenital Cardiac Surgery
• Pediatric Cardiology
• Cardiovascular Surgery

Background:

• Criss-cross heart with double outlet right ventricle (DORV) and combined atrioventricular (AV) and ventriculoarterial (VA) discordance poses significant surgical challenges.
• Standard biventricular repair is often not feasible, leading to frequent single-ventricle palliation.
• Anatomical repair via double switch offers potential for superior long-term outcomes by preserving systemic ventricular function.

Purpose of the Study:

• To describe a surgical strategy for anatomical repair of criss-cross hearts with DORV and AV/VA discordance.
• To detail a modified Senning procedure within a double switch operation for this complex defect.
• To highlight critical preoperative assessments and surgical considerations.

Main Methods:

• Utilized preoperative imaging (echocardiography, CT angiography, cardiac catheterization) for operability assessment.
• Performed a double switch operation including VSD baffle closure, arterial switch, and a modified Senning atrial switch.
• Employed a pedicled autologous pericardial baffle augmented with bovine pericardium for the Senning component to prevent venous pathway narrowing.

Main Results:

• The described technique allows for biventricular repair in complex criss-cross hearts with severe malalignment.
• Aims to achieve unobstructed venous pathways and minimize arrhythmia risk.
• Facilitates long-term left ventricular systemic circulation.

Conclusions:

• Careful patient selection and meticulous surgical execution are crucial for successful outcomes.
• This modified double switch approach offers a viable option for biventricular repair in challenging congenital heart disease.
• Preserves systemic ventricular function for improved long-term prognosis.