Physiologic Repair of Congenitally Corrected Transposition of the Great Arteries

Abstract

Surgery for congenitally corrected transposition of the great arteries (ccTGA) has evolved overtime. Anatomical repair of ccTGA is now performed with quite satisfactory outcomes in children. The double switch operation has become the preferred surgical procedure in selected cases. Nevertheless, a number of patients with ccTGA still require physiological repair due to complex cardiac associations or impaired systemic ventricular function. This chapter outlines the mechanisms of right ventricular failure in ccTGA. Several "old techniques of repair" were abandoned. The introduction of PA banding has reduced the occurrence of tricuspid regurgitation and has allowed, in some cases, anatomical repair after proper LV retraining. The indications for TV repair and replacement, the place of the Fontan operation or heart transplantation are discussed. The decision to proceed with physiologic versus anatomic repair and the timing of operation is individualized.