Arterial switch with internal pulmonary artery banding - A new palliation for TGA and VSD in complex cases

In most cases, one stage repair by arterial switch operation (ASO) is the o ptimal treatment for neonates with transposition of the great arteries (TGA ), Nevertheless, a ventricular septal defect (VSD) associated with TGA rema ins a major risk factor for early death and reoperation after complete repa ir in neonates with complex anatomy, A new palliative approach for such spe cific cases is proposed. An internal pulmonary artery banding (IPAB), as th at already used to palliate other cardiac malformations, is performed in as sociation with ASO instead of VSD closure. At the end of ASO, a circular po lytetrafluorethylene (PTFE) patch with a 4-mm central hole is oversewn into the neo-pulmonary trunk. We adopted this method ina 17-day-old boy with TG A, VSD, hypoplastic tricuspid valve and diminutive right ventricle. After t he operation the child thrived and was doing well without medication. Satis factory growth of the right ventricle and tricuspid valve was observed by e chocardiography during the following months. The patient successfully under went VSD closure and IPAB removal 2 years after the first procedure. ASO wi th IPAB could be appriopriate ib all forms of TGA and VSD in which VSD clos ure appears too challenging in the neonatal period and in patients with unc ertain suitability for biventricular repair. We preferred to use IPAB inste ad of classic PAB in order to reduce the risk of pulmonary valve damage, pu lmonary artery distortion, and above all pulmonary artery dilatation and re lated coronary compression. In the presented case the strategy as well as I PAB worked according to our expectations.