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Chapter 22 - d-Transposition of the Great Arteries (Atrial Switch)

from Section 4 - Complex Mixing Lesions

Published online by Cambridge University Press:  09 September 2021

By
Denise C. Joffe  and
Michael J. Eisses
Edited by
Laura K. Berenstain  and
James P. Spaeth
Laura K. Berenstain
Affiliation:
Cincinnati Children's Hospital Medical Center
James P. Spaeth
Affiliation:
Cincinnati Children's Hospital Medical Center
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Summary

In “simple” dextro-transposition of the great arteries the great vessels originate from the wrong ventricle. Blood flows in a parallel fashion with deoxygenated blood recirculating to the body and oxygenated blood recirculating to the lungs. The resultant physiology is not compatible with life unless there is mixing between circulations. In the late 1960s, ingenious ways of rerouting atrial blood to the opposite ventricle were developed, and atrial switch procedures became the procedure of choice for the next 15–20 years until the arterial switch operation became standard treatment for this lesion. The atrial switch is no longer performed, but as of 2008, there were an estimated 9000 adult congenital heart disease patients in the United States who had undergone atrial switch procedures performed for the correction of dextro-transposition of the great arteries. This chapter discusses the assessment and management of an adult patient who underwent the atrial switch procedure and the perioperative concerns involved in care of these patients.

Keywords

anesthesiaarterial switch operationatrial switch procedurecongenital heart diseaseMustard procedureNikaidohpediatricpulmonary stenosisRastelliSenning proceduretransposition of the great arteries (TGA)d-TGAventriculoarterial discordance
Type
Chapter
Information
Congenital Cardiac Anesthesia
A Case-based Approach
 , pp. 145 - 157
Publisher: Cambridge University Press
Print publication year: 2021

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References

Suggested Reading

Cohen, M. S., Eidem, B. W., Cetta, F., et al. Multimodality imaging guidelines of patients with transposition of the great arteries: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2016; 29: 571–621.CrossRefGoogle Scholar
Cuypers, J. A., Eindhoven, J. A., Slager, M. A., et al. The natural and unnatural history of the Mustard procedure: long-term outcome up to 40 years. Eur Heart J 2014; 35: 1666–74.CrossRefGoogle ScholarPubMed
De Pasquale, G. High prevalence of baffle leaks in adults after atrial switch operations for transposition of the great arteries. Eur Heart J Cardiovasc Imaging 2017; 18: 531–5.Google ScholarPubMed
Dobson, R., Dantan, M., Nicola, W., et al. The natural and unnatural history of the systemic right ventricle in adult survivors. J Thorac Cardiovasc Surg 2013; 145: 1493–50.CrossRefGoogle ScholarPubMed
Haeffele, C. and Lui, G. K. Dextro-transposition of the great arteries: long-term sequelae of atrial and arterial switch. Cardiol Clin 2015; 33: 543–58.CrossRefGoogle ScholarPubMed
Joffe, D. C., Krishnan, S. K., Eisses, M., et al. The use of transesophageal echocardiography in the management of baffles leaks in a patient with transposition of the great arteries. AA Case Rep 2018; 1–3.Google Scholar
Maxwell, B. G., Wong, J. K., Kin, C., et al. Perioperative outcomes of major noncardiac surgery in adults with congenital heart disease. Anesthesiology 2013; 119: 762–9.CrossRefGoogle ScholarPubMed
Stout, K. K., Daniels, C. J., and Aboulhosn, J. A. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation 2018; 139: e698–800.Google Scholar
Warnes, C. A. Transposition of the great arteries. Circulation 2006; 114: 2699–709.CrossRefGoogle ScholarPubMed

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