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.

This chapter provides an overview of the congenital cardiac condition known as d-transposition of the great arteries and its most modern form of repair, the arterial switch operation. Using a case-based format, the chapter aims to describe the neonatal physiology prior to repair, the surgery itself, and what anesthetic and other healthcare providers can expect as major postoperative sequelae long term. The chapter discusses how these salient details can affect pre-, intra-, and postoperative management of these patients undergoing noncardiac surgery.