An Alternative Technique for the Atrial Switch Operation for Transposition of the Great Arteries in an Unoperated Adult Patient

Abstract

We report a 26-year-old patient with d-transposition of great arteries, intact ventricular septum, and an atrial septal defect. The relevant literature on late natural survivors with this condition is reviewed and the technical aspects of an alternative technique for accomplishing a successful atrial switch in this situation are discussed.

Atrial Switch Operation in a Late Presenter With d-Transposed Great Arteries, Juxtaposed Atrial Appendages, and Bilateral Superior Caval Veins

“…Unoperated patients with d-TGA who survive into adulthood are a rarity and very few such cases are reported in the English language medical literature. 2,5,6 Reported patients were 38, 44, and 26 years of age, respectively. The first one had a VSD, whereas the two others each had a large ASD.…”

“…2,3 Therefore, we performed the atrial switch using the principles of the Senning operation, augmentation of the right atrium, and the Schumaker's modification of using the in situ pericardium. 2,3,9,10 We expect that with a combination of these techniques, the likelihood of complications related to the systemic and pulmonary venous baffles will be minimized. We believe that it is important to tailor the atrial switch operation to the needs of the patient when such unusual situations are encountered to achieve satisfactory technical results.…”

Primary care management of patients with common arterial trunk and transposition of the great arteries

“…Unlike patients with common arterial trunk, it is exceedingly rare for patients to present to clinic outside of the neonatal period with unrepaired arterial transposition. 3 Of those who present as neonates, they are likely to demonstrate cyanosis or evidence of congestive heart failure, reverse differential cyanosis -if in the presence of coarctation of the aorta -a gallop rhythm, or a murmur of either pulmonary valve stenosis or a ventricular septal defect. Although the vast majority of patients without repair of their arterial transposition do not survive past the age of 1 year, 3 those who do are likely to have a large defect of either the atrial or the ventricular septum, the left ventricle is likely to be de-trained, and they would probably need to undergo an atrial switch procedure, such as a Senning or a Mustard.…”

“…Unlike patients with common arterial trunk, it is exceedingly rare for patients to present to clinic outside of the neonatal period with unrepaired arterial transposition 3 . Of those who present as neonates, they are likely to demonstrate cyanosis or evidence of congestive heart failure, reverse differential cyanosis – if in the presence of coarctation of the aorta – a gallop rhythm, or a murmur of either pulmonary valve stenosis or a ventricular septal defect.…”

“…Of those who present as neonates, they are likely to demonstrate cyanosis or evidence of congestive heart failure, reverse differential cyanosis – if in the presence of coarctation of the aorta – a gallop rhythm, or a murmur of either pulmonary valve stenosis or a ventricular septal defect. Although the vast majority of patients without repair of their arterial transposition do not survive past the age of 1 year, 3 those who do are likely to have a large defect of either the atrial or the ventricular septum, the left ventricle is likely to be de-trained, and they would probably need to undergo an atrial switch procedure, such as a Senning or a Mustard. The history in any patient without repair of their arterial transposition would include that of feeding efficacy and evidence of cyanosis.…”