Aims: Congenitally corrected transposition of the great arteries (cTGA) is a rare defect
characterized by discordant atrioventricular and ventriculoarterial connections. Correction
of the associated defects alone and leaving the morphologic right ventricle in systemic
position is a low risk procedure, but can negatively affect the patient's long-term
prognosis. Anatomic repair by double switch technique (complicated procedure) may
improve survival of patients by establishing the morphologic left ventricle in the
systemic circulation.
Aim: To present changes in our surgical strategy of cTGA between 1975–2005.
Methods: 66 palliative and corrective cardiac surgical procedures were performed on 44 children
with an early mortality of 7.5%. Types of surgery included pacemaker implantation
(11), palliative procedures (26), „one-ventricle repair“ (12), correction of the associated
cardiac defects (15), anatomic correction (2). Follow-up period ranged from 1–30 (mean
14) years, late mortality occurred in 2 patients (with right ventricular dysfunction).
The experiences from the managements of 176 Senning and 168 Jatene procedures helped
us to perform the anatomic correction of the cTGA. We would like to present a case
of a 2.5-year-old girl (7kg) with cTGA, VSD, previous palliative procedure, who was
corrected by double switch technique and patch closure of VSD. 17 months after the
operation the girl is doing well without any medication.
Conclusions: Anatomic correction in infants or small children provides the best long-term results
and should be the first surgical choice. If anatomic conditions are not suitable for
total correction, the associated defects will determine the type of the surgical procedure.
Keywords: double switch, congenitally corrected transposition of the great arteries
