Palliative Arterial Switch Operation in the Context of Multiple Ventricular Septal Defects, Potentially Biventricular and Univentricular Hearts With Malposed Great Arteries

Abstract

This study is an examination of our unit's experience with palliative arterial switch in univentricular and potentially biventricular hearts with transposition of the great arteries (TGA). These patients were divided into three groups based on their physiology. (a) Single ventricle physiology (n = 8), in which all the patients had univentricular hearts, TGA, and subaortic stenosis (SAS). (b) Borderline biventricular physiology (n = 4), in which the patients had TGA, ventricular septal defect (VSD), and hypoplastic right ventricle (RV). (c) Biventricular physiology (n = 3), in which the patients had TGA and multiple VSDs. In all, 12 (80%) patients survived. Seven of these have undergone second stage surgery (cavopulmonary shunt, n = 5; biventricular repair, n = 2). Palliative arterial switch is an alternative to Norwood procedure and modifications thereof for managing SAS in single ventricle with malposed great arteries. Palliative switch with adjunctive pulmonary artery band may be a temporizing measure in TGA with multiple VSDs, where the VSDs are judged to be inaccessible through the tricuspid valve or through either of the great arteries. It may also be utilized for TGA and hypoplastic RV instead of committing them to univentricular pathway and keeping the option of biventricular repair.