COMBINED ATRIAL AND ARTERIAL SWITCH PROCEDURE FOR CONGENITAL CORRECTED TRANSPOSITION WITH VENTRICULAR SEPTAL-DEFECT

Objectives-A combined atrial and arterial switch procedure was perform ed in selected patients with congenitally corrected transposition to e stablish the morphological left ventricle as the systemic ventricle, I mmediate and early follow up results are presented. Background-Progres sive right ventricular dysfunction and tricuspid regurgitation are com mon in patients with congenitally corrected transposition who undergo repair of associated lesions. A surgical procedure which re-establishe s the left ventricle as the systemic ventricle should improve function al results. Methods-Four symptomatic children aged from 9 months to 3 years 1 month (mean 2 years 3 months) with congenitally corrected tran sposition and ventricular septal defect underwent both an atrial and a rterial switch procedure and were followed up for a mean of 12 months (range 6-21 months). Results-There were no early or late deaths, Condu ction abnormalities worsened in two patients. Hospital stay ranged fro m 8 to 17 days (mean 13 days), The cardiothoracic ratio decreased from a mean (range) of 0.65 (0.6 to 0.71) to 0.58 (0.52 to 0.6). Currently , three patients are in functional class I and one child is in functio nal class II. Conclusions-The combination of an atrial and an arterial switch procedure in symptomatic children with congenitally corrected transposition establishes the left ventricle as the systemic ventricle . The initial experience is encouraging with excellent immediate and e arly follow up results.