The Senning procedure for repair of d-transposition of the great arteries.

Abstract

We report our results with the Senning procedure for repair of d-transposition of the great arteries (d-TGA) including techniques that we feel facilitate the operation. When the atrial septal flap is deficient at the site of an atrial septal defect, the flap is filleted to enlarge it using living tissue. This also has the effect of thinning the septal flap which enlarges the left pulmonary vein pathway located posterior to the floor of the new caval tunnels. Another technique includes the use of the upper end of the sulcus terminalis in the construction of the roof of the new caval tunnels. The upper posterior rim of the right atriotomy is left external to this suture line and can be used in construction of the new pulmonary venous pathway. The latter suture line is inferior to the SA node and can be placed expeditiously and with less chance of damaging the SA node. Use of this technique has resulted in a reduced incidence of late arrhythmias. Following the Senning procedure in 40 patients there were no hospital deaths, but there were two late deaths. The Senning operation is currently a very satisfactory alternative for repair of d-TGA when arterial switch repair cannot be performed.