Outcomes of double switch procedure in patients with congenitally corrected transposition of the great arteries with or without associated VSD

At 32 weeks of gestation, a male fetus with congenitally corrected transposition of the great arteries developed hydrops fetalis caused by a combination of mitral valve regurgitation and tricuspid valve regurgitation (TR). We performed a pulmonary artery banding (PAB) at 108 days old for gradually progressing TR, after confirming that a balloon dilatation test in the main pulmonary artery reduced TR. As the patient grew, the PAB became tighter and systolic blood pressure in the morphological left ventricle increased. At present, the patient is waiting for a double switch operation.

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Double switch operation in a young infant

Cardiology in the Young ◽

10.1017/s1047951104006110 ◽

2004 ◽

Vol 14 (6) ◽

pp. 661-663 ◽

Cited By ~ 1

Author(s):

Nobuyuki Ishibashi ◽

Mitsuru Aoki ◽

Tadashi Fujiwara

Keyword(s):

Tricuspid Regurgitation ◽

Septal Defect ◽

Arterial Switch Operation ◽

Young Infant ◽

Severe Tricuspid Regurgitation ◽

Young Infants ◽

Switch Operation ◽

Double Switch ◽

Congenitally Corrected Transposition ◽

Corrected Transposition

We performed a combined Senning and arterial switch operation on a 2-month-old patient with congenitally corrected transposition, Ebstein's malformation producing severe tricuspid regurgitation, ventricular septal defect, pulmonary hypertension, and congestive heart failure. The tricuspid regurgitation was improved. The double switch operation has the advantage of improving the function of the systemic atrioventricular valve, especially in newborns or young infants in whom the outcome of the valvar repair is poor.

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Left Ventricular Retraining and Double Switch in Patients With Congenitally Corrected Transposition of the Great Arteries

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135116683939 ◽

2017 ◽

Vol 8 (2) ◽

pp. 203-209 ◽

Cited By ~ 11

Author(s):

Ali N. Ibrahimiye ◽

Richard D. Mainwaring ◽

William L. Patrick ◽

Laura Downey ◽

Vamsi Yarlagadda ◽

...

Keyword(s):

Left Ventricle ◽

Pressure Ratio ◽

Complex Form ◽

Left Ventricular ◽

Select Group ◽

Double Switch ◽

Subpulmonary Stenosis ◽

Congenitally Corrected Transposition ◽

Corrected Transposition

Purpose: Congenitally corrected transposition of the great arteries (CC-TGA) is a complex form of congenital heart defect with numerous anatomic subgroups. The majority of patients with CC-TGA are excellent candidates for a double-switch procedure. However, in the absence of an unrestrictive ventricular septal defect or subpulmonary stenosis, the left ventricle (LV) may undergo involution and require retraining prior to double switch. The purpose of this study was to review our experience with patients having CC-TGA who required LV retraining prior to a double-switch procedure. Methods: This was a retrospective review of 24 patients with CC-TGA who were enrolled in an LV retraining program in preparation for a double-switch procedure. The median age at the time of enrollment for retraining was 11 months (range 1 month-24 years). The average left ventricle to right ventricle pressure ratio was 0.39 ± 0.07 prior to intervention. All 24 patients underwent placement of an initial pulmonary artery band (PAB) for LV retraining. Results: Eighteen (75%) of the 24 patients underwent a double-switch procedure with no operative mortality. Of these 18 patients, 9 had a single PAB and 9 required a second band for retraining. Six patients have not undergone a double-switch procedure to date. Five patients are good candidates for a double switch and are 2 weeks, 3 weeks, 4 weeks, 8 months, and 35 months since their last PAB. One patient died from a noncardiac cause 26 months after PAB retightening. The 18 patients who underwent a double switch were followed for an average of 5 ± 1 years (range 0.1-10.3 years). There has been no late mortality, and only 2 patients required further reinterventions. Conclusion: The data demonstrate that LV retraining has been highly effective in this select group of patients with CC-TGA. The data also demonstrate that the results of the double-switch procedure have been excellent at midterm follow-up. These results suggest that LV retraining and double switch offer a reliable strategy option for patients with CC-TGA.

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