Atrial Switch Operation in the Current Era

Abstract

Although rarely performed today, atrial switch operations continue to have an important role in the management of some forms of congenital heart disease. In developing countries, delayed diagnosis and presentation of patients with transposition of the great arteries is not uncommon. For some patients who are referred for surgery beyond the newborn period, the atrial switch operations are still considered to be the best option. Also, as part of surgical repair of congenitally corrected transposition, an atrial switch operation is combined with arterial switch or the Rastelli procedure as an alternative to physiologic repair. In isolated ventricular inversion (atrioventricular discordance with ventriculoarterial concordance), the atrial switch operation alone leads to complete anatomical correction. Finally, management of late complications of atrial switch operations requires a thorough understanding of the procedures.

Early and mid-term follow-up of patients receiving arterial switch operation: a single-center experience

“…Beyond 3 weeks, left ventricle becomes measurably thinner and left ventricle pressure lower than two-thirds systemic pressure. Consequently, either an atrial switch operation (Senning or Mustard), or a two-stage procedure involving the use of a pulmonary artery band to prepare the left ventricle for a later ASO, should be advocated (17,18). However, late referral of patients with TGA/IVS is common in China.…”

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

“…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.…”

Anteroposterior Pulmonary Venous Anatomy

“…One of the potential problems with the Senning operation, with or without the use of the Shumacker modification, is that existence of what we refer to as a ''small pulmonary venous presence'' lateral to the systemic venous atrium can predispose to development of gradients in the pulmonary venous pathway. 3,5 The pulmonary venous outflow after the Senning repair depends on the size of the pulmonary venous opening lateral to the caval tunnel. The ideal pulmonary venous relationship for a Senning operation is the common superoinferior arrangement ( Figure 1B).…”

“…Here, almost the entire free wall of the right atrium is used to form the caval tunnel, while in situ pericardium almost entirely forms the pulmonary venous baffle. 5,6 In the following description, wherever sidedness is mentioned, it is for a situs solitus arrangement.…”